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COOLER RECEIPT FORM <br /> Client ] I l��O �C _ I�-+nr 1; Project--CAL 7�e-nJ� C �0��C�� <br /> Cooler Received -f)L�°7 /o.4 Cooler Opened o 6/0 7/oi By l) y oN 6yy <br /> Stoned ILC <br /> Was cooler scanned for presense of radioactivity, and noted if found'' Yes No <br /> Were custody seals present on outside of cooler'' Yes ro <br /> a If Yes, were they intact Yes No <br /> b Hov% many, and where" <br /> c Were si�_nature and date correct' Yes Io <br /> Were custodv papers included \\ith the samples9 6e No <br /> Were the custodv papers completer filled out' I <br /> Did you sign and date the custodv papers in the appropriate place° �s do <br /> �k as a shippers packing slip attached to the cooler' (es <br /> �o <br /> V hat Lind of packing material vas used' <br /> U <br /> «as sufficient ice used es \o Temperature of cooler" C_ <br /> Approved by 1 AVO U _ Date _d er» 0 1 <br /> Nt ere all bottles sealed in seperate pla,tic bags' � \o <br /> Did all bottles arrive intact' Yes No <br /> V ere all bottles labled correct!,,`' (lD anal\si, Dates Time,) es No <br /> Did all ID's match the custodv paper\vork' es 'IN o <br /> Were the correct contaii,--- n,:l a „ '_ ,eats required- �' No <br /> Were all VOA vials cnecxed foi headspacer' N/A Ces No <br /> Was sufficient volume of sample sent in all comainers' es No <br /> Were correct preservatives used '' es No <br /> Approved by 'Q IJ Date _-0—CJ_07 10 t <br /> If not approved <br /> a Name of person contacted Date <br /> b Corrective action taken <br />