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THE SEACREST GROUP <br /> 325 INTERLOCKEN PARKWAY <br /> SUITE 205 <br /> BROOMFIELDe COLORADO 80021 <br /> SAMPLE RECEIPT FORM <br /> Project Number 39z/39 t <br /> Date/Initials 1/20 v e 7 <br /> Sam are: <br /> hl ped or Delivered or Messenger <br /> 2. Airbili Present Y NA <br /> NOTES: <br /> * Ambient chin 1 Temp, pH <br /> NOTES: - �• �•�- 4. � <br /> 4. Cooler received Broken/leaking Y <br /> NOTES: <br /> S. Sample Received Broken/Leaking pmproperly Sealed) <br /> Y <br /> NOTES: <br /> S. Samples Properly Preserved (c filed to 4°C) b N <br /> NOTES: <br /> 7. Received within Holding Times A� N <br /> NOTES: <br /> COC Tape Was: <br /> 1. Present on Outer Package Y �1 <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 N <br />