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JU14-09-200,3 17e12 P.06 <br /> WORK ORDER Ov. 03 <br /> Cooler of i <br /> SAMPLE RECEIPT <br /> CLIENT: `FF DATE: +< Af e I <br /> TEMPERATURE-- PLE RECEIVED BY. <br /> CALSCIENCE COURIER: LABORATORY(Other thm Calacience Courier): <br /> Chilled,cooler with temperature blank provided. °C Temperature blank. <br /> Chilled,cooler without temperature blank. 9C IR thermometer. <br /> Chilled and pieced in cooler with wet icer. Ambient temperature. <br /> Ambient and placed in cooler with wet ice. <br /> Ambient temperature. <br /> °C Temperature blank. Initial: <br /> CUSTODY SEAL INTACT: <br /> sample(s): Cooler°®a i No(Not Intact): Not Applicable(WA): <br /> Initial: <br /> 3MPLE CONDITION: <br /> Yes No N/A <br /> Chain-W-Custody document(*)remind with samples......................... ...... .... <br /> Sample container Wml(s)consistent with custody papers..................... ..... ....... <br /> Sample containers)intact and good condition................................... Ad'�....... ....... <br /> Correct containers for analyses reque ........................................ �. .... ....,. <br /> Properpreservation noted on sample label(s)..................................... ...... d::� <br /> VOAvial(s)free of headspace. ...................................................... ..... <br /> Tedlar bag(s)free of condensation.................................................. .... , ....�/ <br /> 'r Initial: <br /> COMMENTS: <br /> ann�wie,rw.,ea aw�nw <br />