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'.he SeaCrest Group Sample Receipt Form Form *: a2 <br />Louisville, CO Effective: November 2003 <br />Project #: ~~p, ~ 2. Z S Sample #: <br />Date: ~ _ Initials: -.-. ~"~, <br />Samples Were: ` <br />1. Shipped Hand Delivered (Messengered.... - ' (circle one) <br />Notes: _ . _ _... <br />.:~ <br />,. . <br />2. Airbill Present ~ . Y;' N NA <br />Notes: <br /> ~_. -'~ <br />3. Chilled to Ship Ambie nt !Chilled t'circle one) <br />Notes: ,.- . ~__----. ~ <br /> ~ <br /> ' Ice <br /><-----'J Blue Ice (circle one) <br /> <br />4. Cooler Received Broken or Leaking <br />Y - ~. <br />~L <br />N ~ <br />NA <br />Notes: ^ <br /> -, <br />5. Sample Received Broken or Leaking Y ~N } NA <br />Notes: _/ <br /> ( <br />6. Received Within Holding Times Y N <br />Notes: <br /> <br />7. Aeration necessary Y ~ NA <br />Notes: <br /> <br />8. Sample Received at Temperature between 0-6° C . Y ~ NA <br />Notes: <br />9. Description of Sample (Color, Odor, and/or Presence of Particulate Matter): <br /> <br />rec'g <br /> DO Temp pH CI <br />Eff ",~- ~ ~ - ." <br />.~ <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 />Time ~ DO ~ pH <br />0 <br />a <br />Y ~~N_ ,-~` --~ <br />Y N -~ L~IA <br />Y ~~ <br />J` <br />Y N (, I" <br />(..~,L~ N <br />