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The SeaCrest Group Sample Receipt Form az <br />Form #: <br />Louisville, CC Effective: January 2003 <br />Project #: _ _ - jG`~ 13 3 <br />Date: ~`Z-` • c-{ <br />Samples Were: -~ <br />1. Shipped Hand Delivered essengered <br />Notes: <br />2. Airbill Present <br />Notes: <br />3. Chilled to Ship <br />Notes: <br />4. Aeration necessary <br />Notes: <br />5. Cooler Received Broken or Leaking <br />Notes: <br />6. Sample Received Broken or Leaking <br />Notes: <br />7. Sample Properly Preserved <br />Notes: <br />8. Received Within Holding Times <br />Notes: <br />Sample #: ~ <br />Initials: ~f-~--, <br />(circle one) <br />N NA <br />Ambie Chilled (circle one) <br />Ice lue !ce circle one} <br />Y '~ ~N NA <br />Y / Tl~ NA <br />Y J' ~I) NA <br />Y r N NA <br />l~ N <br />9. Description of Sample (Color, Odor, and/or Presence of Particulate Matter}: <br />rec'g <br />COC Tape Was: <br />1. Present on Outer Package Y <br />2. Unbroken on Outer Package Y <br />3. Present on Sample Y <br />4. Unbroken on Sample Y N <br />COG Record Was: <br />1. Present Upon Receipt of Sample ~ N <br />DO Tem H CI <br />Eff ~•(a f~• ~'•.C7 ruin <br />Rec' <br /> <br />Time ~ DO ' pH <br />0 <br /> <br />