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SeaCrest Group Sample Receipt Form Form #: 42 <br />Louisville, CO Effective: December 2008 <br />Project #: <br />Date: SvS <br />Sa <br />Shipped Hand Delivered Messengered <br />otes: <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 Received at Temperature between 0-60 C . <br />Notes: <br />Sample #: <br />Initials: / <br />(circle one) <br />Ambient E!!Y (circle one) <br />et IC Blue Ice (circle one) <br />Y (0 NA <br />Y 0 NA <br />Y N <br />Y N NA <br />Y N NA <br />9. Description of Sample (Color, Odor, and?r Presence of Particulate Matter): <br />eff: /VP Pq <br />rec'g <br />Aeration <br />Temp DO m /L DO %Sat) H Cond Time DO (m iL DO msat> H <br />Fff <' n 61.9 An.. 1 -2 2) n) <br />Custody Seals: <br />1. Present on Outer Package <br />2. Unbroken on Outer Package <br />3. Present on Sample <br />4. Unbroken on Sample <br />Custody Documentation: <br />1. Present Upon Receipt of Sample <br />Ye <br />Y N <br />Y NA <br />Y N <br />Y NA <br />