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The E:~Crest Group Sampie Receipt Form Form p: 42 <br />Louisville, CO Effective: November 2003 <br />Project #: _ ~~ ~ (`"~" <br />Date: ~~~~7~ <br />Samples Were: -~ -_ <br />1. Shipped Hand Delivered Messengered ~' <br />Notes: <br />2. Airbill Present <br />Notes: <br />3. Chilled to Ship <br />Notes: <br />i? ~ <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 />Ambient hilted ~ (circle one) <br />Ice Blue lce (circle one) <br />Y --~ NA <br />Y ~N 1 NA <br />/ Y / N <br />~~ NA <br />N NA <br />7. Aeration necessary Y <br />Notes: <br />8. Sample Received at Temperature between 0-6° C . Y <br />Notes: <br />9. Description of Sample (Color,.Odor, and/or Presence of Particulate Matter): <br />eff: ~1~51,1-t.., C~-~ i ~ ~e•~js. IJa (1~~- <br />~i <br />rec'g <br /> DO Temp pH CI <br />Eff ~. -1 Z- - I ~'I' • ~ E <br />Rec'g <br />COC Tape Was: <br />1. Present on Outer Package <br />2. Unbroken on Outer Package <br />3. Present on Sample <br />4. Unbroken on Sample <br />COC Record Was: <br />1. Present Upon Receipt of Sample <br />Sample #: <br />Initials: <br />(circle one) <br />/ ~ -' <br />Y ~~ NA <br />Y <br />Y <br />Y <br />Y <br />Y <br />Time ~ DO ~ pH <br />0 <br />a <br />..~-~.~ <br />.`~,.. <br />N <br />N G~ <br />N <br />