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The SeaCrest Group Sample Receipt Form <br />Form #: 42 <br />Louisville, CO Effective: November 2003 <br />Project #: ~~ <~~~ ~ <br />Date: ~~5,' ~~ C <br />Samples Were: ._ <br />1. Shipped Hand Delivered (~Messengered •• <br />Notes: ~--•___.___._..._..__.: <br />2. Airbill Present y <br />Notes: <br />3. Chilled to Ship <br />Notes: <br />Ambient Chille (circle one) <br />Ice " Blue Ice (circle one) <br />4. Cooler Received Broken or Leaking Y ~N NA <br />Notes: <br />5. Sample Received Broken or Leaking Y ~ NA <br />Notes: <br />6. Received Within Holding Times ~ N <br />Notes: <br />7. Aeration necessary Y ~ NA <br />Notes: <br />8. Sample Received at Temperature between 0-ti° C . ~ N NA <br />Notes: <br />9. Description of Sample (Color, Odor, and/or Presence of Particulate Matter): <br />eft: rl t7 oG~ Or ~ L ~ UUt.(~ wl' S~+'h-~- PM, <br />rec'g <br /> DO Temp pH CI <br />Eff ~. (,~ 7 ~ <br />Rec'g <br />COC Tape Was <br />1. Present on Outer Package Y <br />2. Unbroken on Outer Package Y N <br />3. Present on Sample y <br />4. Unbroken on Sample Y N <br />Sample #: - <br />Initials: N L~ <br />(circle one) <br />N lA~ <br />Time ~ DO ( pH <br />o ~-- <br />a ~~ <br />NA <br />N <br />COC Record Was: <br />1. Present Upon Receipt of Sample ~ N <br />