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N%.O/ <br />Cooler Receipt Form <br />\V -V' <br />Client: _ Project: q i 3�1' / Z�. --f6 <br />Cooler Received: y 13 -oma. Cooler Opened: ct ,3- oc <br />Signed--•��� � �,.—.._ <br />Was cooler scanned for presence of radioactivity, and noted if found? <br />Were custody seals present or, outside of cooler? <br />a: If Yes, were they intact? <br />b: Were signature and date correct? <br />Were custody papers completely filled out? <br />Did you sign and date the custody papers in the appropriate place? <br />Was a shippers packing slip attached to the cooler? <br />What kind of packing ir_ateriai was used': Ice - <br />Yes / <br />Yes / X10) <br />Yes / No <br />Yes / No <br />E),-z/ No <br />:Yes / No <br />Yes I � <br />Was sufficient ice used? Xe. /'\o TempCrature: (, 7L -C _Dare: _ q- � <br />Were al l bottles sealed in plastic bags? Yes/( D, <br />Did all bottles arrive intact? (&' No <br />Were all bottles Iabeled correctly? (ID, Analvsis, Dates, Times) �,� No <br />Were the correct containers included for the tests required? Yeses ; No <br />Were all VOA vials checked for headspace? � / :Tes I No <br />Was sufficient . oluitie of sample sent in all containers? Ye. / No <br />Were correct preservatives used? (-V-c�s /No <br />Approv-gid by: Date: 4-' 02 <br />If not ::approved: 1`i _ n contacted Date: <br />