Laserfiche WebLink
�7ls�ra�c+� <br /> A v,ronrnentar WORK ORDER #: O2-Fo <br /> Cooler �� of _ 1 <br /> SAMPLE RECEIPT FORM <br /> 1 z <br /> CLIENT. HP L eA �S DATE � Z <br /> TEMPERATURE — SAMPLES RECEIVED BY <br /> CALSCIENCE COURIER LABORATORY (Other than Calscience Courier) <br /> ' Chilled, cooler with temperature blank provided OC Temperature blank <br /> Chilled, cooler without temperature blank °C IR thermometer <br /> Chilled and placed in cooler with wet ice Ambient temperature <br /> Ambient and placed in cooler with wet ice <br /> Ambient temperature <br /> ' ✓� °G Temperature blank Initial <br /> CUSTODY SEAL INTACT <br /> Sampie(s) Cooler No (Not Intact) Not Applicable (NIA) <br /> Initial <br /> SAMPLE CONDITION <br /> Yes No NIA <br /> Chain-Of-Custody document(s) received with samples <br /> Sample container label(s) consistent with custody papers <br /> Sample container{s} intact and good condition ✓ <br /> Correct containers for analyses requested ✓l <br /> Proper preservation noted on sample label(s) J <br /> VOA vial(s)free of headspace <br /> ' Tedlar bag(s) free of condensation <br /> Initial <br /> I <br /> COMMENTS <br /> I <br /> I I ll <br /> II <br /> I I I I l 1 <br /> i 1 <br /> � (II <br /> 11 I I <br /> h I II I 'J <br />