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jll�nvrronrr onto WORK ORDER #: 02-® [j] - E U R [11 <br /> 8gb-Ora3fop tes. Inc- <br /> Cooler of I <br /> SAMPLE RECEIPT FORM <br /> 1 ` <br /> CLIENT b -E Lmb._ CSCZM19v DATE 0 S 7- <br /> TEMPERATURE <br /> TEMPERATURE -- SAMPLES RECEIVED BY <br /> CALSCIENCE COURIER LABORATORY (Other than CaIscience Courier) <br /> ' Chided, cooler with temperature blank provided °C 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 /> ' ,3 °C Temperature blank Initial <br /> ' CUSTODY SEAL INTACT. <br /> Sample(s) Cooler No (Not Intact) Not Applicable (NIA) v <br /> �i 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 v <br /> ' Proper preservation noted on sample label(s) v <br /> VOA vial(s) free of headspace <br /> ' Tedlar bag(s)free of condensation <br /> I ' <br /> Initial _ <br /> I <br /> COMMENTS. <br /> I <br /> I <br /> , <br /> I ' <br /> i <br /> I , <br /> 1 <br /> i I I f I ,i,l <br />