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The SeaCrest Group <br />Broomfield, Colorado <br />Sample Receipt Form <br />Formivo.: ~~o <br />ggbctive: May, 1998 <br />Project Number ~ ~ 3 ~ Sample Number / <br />Date //' ZS -Ql ~ ~~~~~ <br />Samples Were: <br />1. S~or Hand Delivered or Messengered (Circle One) <br />NOTES: (Please note name of shipper or messenger service) <br />~P <br />2. Air Bill Present: Y <br />NOTES: <br />3. Ambient or Chilled (Cucle One) Ice or Blue Ice (Circle One) Temp. °C <br />NOTES: ~ LZ•9 <br />~~g <br />4. Cooler Received Broken or Leaking Y <br />NOTES: <br />5. Sample Received Broken or Leaking (Improperly Sealed) Y <br />NOTES: <br />6. Sample Properly Preserved (4°C) Y <br />NOTES: <br />7. Received Within Holding Times <br />NOTES: <br />8. Description of Sample (Color, Odor, and/or Presence of Particulate Matter) <br />EFF: ~¢w~ ~-, c~nJ~,r\- .dnm~ cl.-~tp-~-e-aa.~-~'~ OclhlL+.a~ <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 />I. Present Upon Receipt of Sample <br />NA <br />pH CI <br />~ ~ ~~ <br />NA <br />I~ NA <br />O <br />N <br />Y <br />Y N I y <br />Y <br />Y N ,~ <br />N <br />