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The SeaCrest Group <br />Broomfield, Colorado <br />Form No.: 036 <br />Effective: May, 1997 <br />' Sample Receipt From <br />Projec't/Number J"/ "/ l c ~ Sample Number <br />Date_ `i • g~~! ~C, ~{5 Initials G~-- <br />Sa ere: <br />1. Shippe r Hand Delivered or Messengered (Circle One) U(~~ <br />NOTES: (Please note name of shipper or messenger service) <br />2. Airbill Pres@nt <br />NOTES: <br />3. Ambient or Chilled irc:~ One) <br />NOTES: <br />Ice or Blue Ic (Circle One) D.O. <br />Rec'g ~~S <br />Y ~N NA <br />Temp. °C pH ~ <br />Y ~ NA <br />4. Cooier Received Broken or Leaking <br />NOTES: <br />5. Sample Received Broken or Leaking (Improperly Sealed) <br />NOTES: <br />6. Sample Properly Preserved (4°C) <br />NOTES: <br />7. Received Within Haldin5 Times <br />NOTES: <br />Y ~ NA <br />Y <br />U N <br />8. Description Of Sample (Color, Odor, and/or Presence of Particulate Matter) <br />EFF: /to odor ~ ~;~ ~ ~~o,r E ~ c~~c..~f5 <br />REC'G: <br />COC Tape Was: <br />1. Present On Outer Package Y O <br />2. Unbroken On Outer Package Y N NA <br />3. Present On Sample Y <br />4. Unbroken On Sample Y N NA <br />COC Record Was: <br />1. Present Upon Receipt Of Sample ~ N <br />