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SeaCrest <br />11 Group Sample Receipt Form <br />Louisville, CO <br />Project #: `4 <br />Date: <br />Sa plq?Were: <br />1.(Shipp Hand Delivered Messengered <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 />Form #: 42 <br />Effective: December 2008 <br />Sample #: I <br />Initials: pa? <br />(circle one) <br /> <br />Ambient Chilled (circle one) <br />We 4 Blue Ice (circle one) <br />Y CN NA <br />Y <br />t \ 1 <br />Y N <br />NA <br />7. Aeration necessary Y N ' NA <br />Notes. <br />8. Sample Receive at Temperature between 0-6'C . Y NA <br />Notes: f?fyovPCB I DY ?- <br />9. Description of Sample (Color, Odor, and/or Presence of Particulate Matter): <br />eff: Cgre?er, tom,, Gd0v I(?SS; l c? 'v?'\ <br />rec'g <br />Aeration <br />Temp DO m /L) DO (%sat) H Cond Time DO (mg/L) DO (%Sat) H <br />Custody Seals: . <br />1. Present on Outer Package Y <br />2. Unbroken on Outer Package Y <br />3. Present on Sample <br />4 <br />Unbroken on Sam <br />le Y <br />Y N N y` <br />. <br />p <br />Custody Documentation: /I <br />1. Present Upon Receipt of Sample (`_Y N