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The SeaCrest Group Sample Receipt Form Form n: az <br />Louisville, CO EHec[ive: January 2003 <br />Project #: ~O 3 Z3 <br />Date: ~"I~ ~ ~3 <br />Samples_1N,pre: <br />1Shipped/ Hand Delivered Messengered <br />Notes: v QS <br />2. Airbill Present <br />Notes: <br />3. Chilled to Ship <br />Notes: <br />4. Aeration necessary <br />Notes: <br />Cri <br />~;:~ <br />~` ~~~ <br />G <br />Sample #_ <br />Initials: <br />(circle one) <br />Y ~N NA <br />Ambient Chilled (circle one) <br />Ice lue ice : (circle one) <br />Y ~ NA <br />5. Cooler Received Broken or Leaking Y ~ NA <br />Notes: <br />6. Sample Received Broken or Leaking Y ~ NA <br />Notes: <br />7. Sample Properly Preserved Y ~ NA <br />Notes: J,y°(~ <br />.~ <br />8. Received Within Holding Times ~ N <br />Notes: <br />9. Description of Sample (Color, Odor, and/or Presence of Particulate Matter): <br />eff: (3rc~a~i,.c. 0 1,~.; ~ yei,(era %~;~~ <~lor ~ (ol5 sw,~_(i ~... <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 />COC Record Was: /~-~_ <br />1. Present-Upon Receipt of Sample (~Y ~ N <br /> DO Tem H CI <br /> <br />Rec' <br />,~_-q-~~ <br />~~ <br />-.. - <br />NA', <br />~ Time ~ DO ~ pH <br />0 <br />a <br />eiw~n = v , ~i z z <br />