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The :;-ea:;rest Group Sample Receipt Form Form #: 42 <br />Louisville, CO Effective: November 2003 <br />Project #: 3U~ - 08 <br />Date: cat-{ ~,~ ~-`7 - <br />Samples Were: ~.__...____._____-, <br />1. Shipped Hand Delivered Messengered <br />Notes: ~~ ~ ~ ---~- <br />2. Airbill Present <br />Notes: <br />3. Chilled to Ship <br />Notes: <br />4. Cooler Received Broken or Leaking <br />Notes: <br />5. Sample Received Broken or Leaking <br />Notes: <br />6. Received Within Holding Times <br />Notes: <br />7. Aeration necessary <br />Notes: <br />8. Sample Properly Preserved <br />Notes:~,,,~s },o h,ryh <br />Sample #: - <br />Initials: 4{7 <br />(circle one) <br />Y ~ NA <br />Ambient hilted (circle one) <br />Ice ~e Ice (circle one) <br />~____-.- <br />Y ~ NA <br />Y ~ NA <br />~. N <br />Y ~ NA <br />Y ~ NA <br />9. Description of Sample (Color, Odor, and/or Presence of Particulate Matter): <br />eff: Szr",- UZo~ <br />Cyrll~o.>M)~ 1~1,~D C:~\r}F.y d:~(~ M~..arl ~%Nt <br />rec'g <br /> DO Tem H CI <br />Eff 10.9 It,.6 8.1 0, oZ <br />Rec' <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 />Time ~ DO ~ pH <br />-~ <br />~, - <br />N <br />~J <br />COC Record Was: <br />1. Present Upon Receipt of Sample ~ N <br />