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(~. .~ .. ~ yin <br />. 5lrs. ~e ~:;; Sample Receipt Form <br />Project #: ~ ~fj 3 ~ Z <br />Date: ) J) ~j OS <br />Samples Vr/ere. <br />1. Shipped Hand Delivered Ntessengered <br />moles: - <br />2. Airbill Present <br />Notes: Y <br />3. Chilled to Ship <br />Notes: <br />EHxLve Form p J? <br />Noverr~pcr 2001 <br />Sample #: <br />Initials: ~ <br />(circle one) <br />J NA <br />Ambient Chilled ' ctr <br />:-- ( de one) <br />r' <br />Ice Blue Ice (drde me) <br />~3. Cooler Received Broken or Leaking <br />Notes: Y N ~ NA <br />~' <br />5. Snrnpl~~ Received Broken or leaking ,~ - <br />":otes Y ~J NA <br />6. Received within Holding Times <br />Notes: Y ~ N <br />7 Aerationnecessary <br />Notes: Y © NA <br />8. Sample ,Received at Temperature between 0-6° C . <br />Notes: ~ N NA <br />9. Uescripton of Sample (Color, Odor, and/or Presence of Particulate Malter): <br />,.rr: pDO~~oS'~ J~lrHle {~~tlr I;~,hk bca~~~~ color <br />rec'9 <br />DO Temp pH CI <br />Eff Lo. Z. , 3 ~!D <br />Rec'g <br />r-~~~ ~ Tape Was: <br />'resent on Outer Package <br />?. Unbroken on Outer Package Y c,~ <br />Y N <br />- 3. Present on Sample <br />- Y ;~ <br />._t. Unbroken on Sample <br />- Y ~~l <br />_:OC Record YVas: <br />~, <br />^n^t r rrrr~ 4.r. .i,t t C,IRi!'.r `, P i <br />~ Time DO pH <br />e <br />a <br />fV~ <br />~IA~ <br />