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The seacrest croup Sample Receipt Form Form #: 42 <br />t_ouisville, CO Effective: November 2003 <br />Project #: _ _~~c~f p ((c <br />date: j.~s.Uy <br />San~les Were: <br />.'Ship ~, Hand Delivered Messengered <br />Notes: ~,~s <br />2. Airbill Present <br />Notes: <br />3. Chilled to Ship <br />Notes: <br />4. Cooler Received Broken or Leaking <br />Notes: <br />5. Sample Received Broken or Leaking <br />Notes: <br />6. Received Within Holding Times <br />Notes: <br />7. Aeration necessary <br />Notes: <br />Sample #: <br />Initials: <br />(circle one) <br />Y ~ NA <br />,--~ <br />Ambient ilk (circle one) <br />Ice Blue Ice (circle one) <br />C----- <br />Y ~ NA <br />Y ~ NA <br />N <br />Y ~ N~ NA <br />8. Sample Properly Preserved Y ~~ NA <br />Notes: ~~~in reas~:u~t{le <br />~~.z.,~,e } cat <br />9. Description of Sample (Color, Odor, and/or Presence of Particulate Matter): <br />eff: ----7 slrSl~Fl~ Clov~~~ + n1or~ ; yes <br />rec'g <br /> DO Tem H CI <br />Eff t,. _ ~. ~f 6. I ArD <br />Rec' <br />COC: Tape Was: <br />1. Present on Outer Package Y O <br />2. Unbroken on Outer Package Y N <br />Present on Sample Y <br />.Unbroken on Sample Y N <br />Time ~ DO ~ pH <br />0 <br />a <br />`N?J <br />NA <br />COC: Record Was: <br />1. Present Upon Receipt of Sample ~ N <br />