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The 5e;~C;rest Group <br />Brdomfield, Colorado <br />Sample Receipt Form <br />Project Number ~~~~ / ~ Sample Number <br />Date ~i ~~ - ~ ~ Initials ~~~ <br />Sam e: ) ,~~~, <br />. Shipp or Hand Delivered or Messengered (Circle One) C// <br />OTES: (Please note name of shipper or messenger service) <br />2. Air Bill Present: <br />NOTES: <br />3, Ambient r Chille (Circle One) Ice Blue Ice (Circle One} (~- 0 - <br />NO Eff 6 . j <br />Rec'g <br />4. Cooler 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 Holding Times <br />NOTES: <br />8. Description o//f Sample (Color,O~99 dor, and/or Presence of Particulate Matter) <br />EFF: Cl~9r I1a DlX4r, r,~ pGr'}~cca ~, Gz..~ <br />U <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 />NOTES: <br />COC Record Was: <br />1. Present Upon Receipt of Sample <br />Form No.: 036 <br />Effective: May, 1998 <br />Y / N / NA <br />Temp. °C pH Cl <br />Y Nli NA <br />Y /N -/ NA <br />Y (N J <br />N <br />Y <br />Y N <br />Y <br />Y N <br /> <br />