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The SezGest Group <br />Louis~dle, CO <br />Project #: ~-1 (` P(° <br />Sample Receipt Form <br />Form n: A2 <br />Effective: January 200 <br />Sampie #: -~-- <br />Initials: <br />Date: (• (Co- y'-I <br />Samples Were: <br />1. Shipped Hand Delivered <br />Notes: <br />2. Airbill Present <br />Notes: <br />3. Chilled to Ship <br />Notes: <br />4. Aeration necessary <br />Notes: <br />5. Cooler Received Broken or Leaking <br />Notes: <br />6. Sample Received Broken or Leaking <br />Notes: <br />7. Sample Properly Preserved <br />Notes: j~r,~ ~ ~-°~ <br />8. Received Within Holding Times <br />Notes: <br />(circle one) <br />N NA <br />Ambient ill (circle one) <br />Ice ue (circle one) <br />Y ( N / NA <br />Y '~ N ) NA <br />Y ~ NA <br />Y 4 ~ NA <br />N <br />9. Description of Sample (Color, Odor, andlor Presence of Particulate Matter): <br />eff: sl .~lnFl~ T~ r htd t cz,.,~..1- d~s~~.., ~~bQ r c..» ~-~""~. <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 />COC Record W as: <br />1. Present Upon Receipt of Sample <br />Y f~ <br />Y N <br />Y 4~ <br />Y N <br />~~ <br /> DO Tem H CI <br />Eff ~ .-"~ ~ S .-~ :~ I h1 <br />Rec' <br /> <br />Time ~ DO ` pH <br />0 <br />m <br />a <br />