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Bmomfield, Colorado <br />gample Recdpt Form <br />Project Number .~'? ~ =~ !C~ SatapleNumber <br />Ettecuve. lnuy, <br />Date I ~ ~ ~ _~ .ti Imt~s , -;- <br />Samples Were: <br />1x SItipped'or Hand Delivered or Messengered (Clrcie One) ~ • } `~ <br />--NOTES: (Please note name of shipper or messenger service) <br />2. Air Bi11 Present: <br />y <br />N <br />NA <br /> NOTES: <br />3. Ambient or Chilled (Circle One) Ice or Blue Ice (Curse One) Temp. °C pH Cl <br /> NOTES: ~--- - Eff ~'..~ '= ; <br /> Rec'g <br />4. Cooler Received Broken or Leaking Y -N NA <br /> NOTES: <br />5. Sample Received Broken or Leaking (~prop~Y Sealed) Y ~ N NA <br /> NOTES: <br />6. Sample Properly Preserved (4°C) Y N <br /> NOTES: ' <br /> ~Y N <br />7. Received Within Holding Tunes <br /> NOTES: <br />8. Description of Sample (Color, Odor, and/or Presence ofParticulate Matter) <br />REC'G: <br />COC Tape Was: <br />1. Present on Outer Package Y t N <br />2. Unbroken on Outer Package Y N NA <br />3. Present on Sample Y N <br />4. Unbroken on Sample Y N NA' <br />NOTES: <br />COC Record Was: Y N <br />1. Present Upon Receipt of Sample <br />