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D;�C-15-20133 13 33 P 06 <br /> AMP <br /> WORK ORDER 0: <br /> _� <br /> tom , Ina- -- <br /> SAMPLEJEEP p ORM <br /> CLIENT: u'C ` A DATE: <br /> TEMPERATURE-- SAMPLES RECEIVED Y- <br /> CALSCIENCE COURIER ' ,Fr Y (Other than Cafsctence Courier). <br /> Chilled, cooler with temperature blank provided T _ + nnperature blank <br /> Chilled, cooler without temperature blank _ 1,1 thermometer <br /> Chilled anq placed in cooler with wet ice r mbient temperature <br /> Ambient and placed in cooler with wet ice <br /> Ambient temperature <br /> °C Temperature blank Initialy/ <br /> CUSTODY SEAL INTACT: <br /> sample(s) —_-- Cooler No (Not Intact) Not Applicable (NIA) <br /> Initial <br /> 11 SAMPLE CONDITION' <br /> NQ NIA <br /> Chain-Of-Gustody docurnent(s) received with sample,- <br /> Semple container label(s) consistent with custody papers <br /> Sample container(s) intact and good condition <br /> Correct rontalners for analyses requested <br /> Proper preservation noted on sample label(s) <br /> VOA v(al(s)free of headspace <br /> Tedlar bags) free of condensation <br /> --- Initial' <br /> COMMENTS: <br />