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Iwo X11 <br /> COOLER RECEIPT FORM <br /> 1003ect: Log No: (pU(X3 <br /> :ooler reca�ve on: an c ec e on by <br /> Signa ure <br /> t <br /> fere custody papers present' , . . . . . . . . . . . . :7-E'3 NO <br /> sere custody papers properly filled out' . . . . . . . . . . . . . . . ..Y'E,'S NO <br /> rere the custody papers signed? . 5 NO <br /> las sufficient ice used? . . . . . . . . . . . . . . . . . . . . . . : NO --T:K <br /> )id all bottles arrive in good condition (unbroken) ' . . . . . . . YErg NO <br /> )id bottle labels match COC? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..= NO <br /> Sere proper bottles used for analysis indicated? . . . . . . . . . . .Y--E NO <br /> 'orrect preservatives used' . . . . . . . . . . . . . . . . . . . . . . . . . . . = NO <br /> OA vials checked for headspace bubbles' . . . . . . . . . . . . . . .YE5 NO <br /> Note which voas ( if any) had bubbles : * <br /> ample descriptor: Number of vials : <br /> 1 <br /> tAll VOAs with headspace bubbles have been set aside so they will not be <br /> used for analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO <br /> gist here all other fobs received in the same cooler: <br /> .Tient Job # NET log\0 # <br /> (coolerrec) <br />