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ZZA <br /> I <br /> ASSOMTED LABOAAMALES <br /> 806 North Batavia-•Orange, California 92968-1225- 7141771-6900 FAX7141538-1209 <br /> 0r <br /> Cooler Receipt Form <br /> Cheat. project: TOC- 17/ <br /> Date Cooler Received:_ � '�- 05 Date Cooler Opened. <br /> z Z ps <br /> Was cooler scanned for presence-of radioactivity ? yespK0, <br /> f If yes was radioactivity results above 25 cpm? Y o <br /> 1 Was a shipper's packing slip attached to the cooler? 'es(Nv <br /> - If the cooler had custody seal(s),were thy signed and intact? <br /> a <br /> Was the cooler packed with:Ice Ice Packs-Bubble wrap <br /> Styrofoam Paper None Other <br /> Cooler Temperature: <br /> *cooler nem to be reserved @ VC with an accept?ble range of 2°-6 aC <br /> If samples were hand delivered do they meet the temp. criteria,which should be @ 40C with <br /> t - an acceptable range of 20- 6 °C? TaKo <br /> If no explain: <br /> Were all samples sealed in plastic.bags ? Yes/Nv <br /> Did all samples arrive intact?If no,inchoate below. Y No <br /> Were all samples labeled correctly ?(ID's Dates,Tunes) if no,indicate below. CYMINO <br /> Gan the tests required be ran with the provided containers, If no indicate t elow. CYesltCo <br /> Was sufcient sample volume sent for all containers 7 (Ye�No <br /> Were any VOA vials received with head space ? Yes/No/ d <br /> Was the correct preservatives used ? YesfNo4Ea <br /> ' If no, see the pH log for a list of samples containers regarding pH <br /> Any other important mformatron <br /> Receiving Department• i r" Date <br /> 1 <br />