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Columbia <br />-Sel"VIC <br />.A.n Employee owned Company <br />COOLER RECEIPT FORM <br />1. Coolers)/Sample(s) received on: ShipI <br />PEEL <br />Shipping Bill # (s): / 1 D 4 2 7 900:1 <br />HERE # of Coolers/Packages : S <br />2. Radiological Screening by: _ Aceeptab R1' acted <br />3. Custody seals on outside. of cooler: YES N N/A <br />If yes, where? Front Rear Lt Side Rt Side <br />Seals intact: YES <br />5090 Caterpillar Road - <br />Redding, CA 96003 <br />Phone: (530) 244-5262 <br />Sample Pcocing/Taggiag by: <br />Cooler(s�Sample(s) Temp's: _s ` & ,I L (� <br />(or) <br />Temp. Blank (if lncluded): <br />6. , Type of packing material (circle): -Ice Blue Ice Bubble Wrap Bubble Bags Zip Locks Webbing <br />Other: <br />7. Custody papers properly filled out (ink, signed, dated, released, etc.)? <br />8. Containers arrived in good condition (not broken, leaking, etc. 4 <br />9. Samples received with adequate holding time remaining to conduct analysis? <br />111.. Container labels complete (i.e. analysis; preservation, date/time, etc.)? <br />11. Container labels and tags agree with.custody papers? <br />12. Correct types of containers used for the tests indicated? <br />a.) Adequate sample received? If not, note on Exception Report. <br />13. Containers supplied by: <br />14. Preserved containers received with the appropriate preservative? <br />PH:-r�pGS (or) See pH log, <br />15. VOA vials free of air bubbles? <br />16. Trip Blank preparation date: <br />17. Volatile Soil samples: Encores or Plugs in Vials <br />YES NO /A <br />CAS Other k14 <br />•• <br />Freezer or GC/MS Date: Tune; N/ <br />See Exception Report for discrepancies. <br />Rev. 8/18/2004/ds <br />M" <br />J <br />7 <br />v <br />I" <br />1 <br />1 <br />1 <br />1 <br />