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Cooler ID No. STL WORK ORDER NO. 122354 <br /> COOLER RECEIPT FORM <br /> PROJECT 246-0783-003 98996184 <br /> COOLER RECEIVED ON 7/22 AND OPENED ON 7122 BY KP <br /> (SIGNAT ) <br /> TEMPERATURE UPON RECEIPT: COOLER 5.6 <br /> TEMP. BLANK 7 <br /> 1. Were custody seals on outside of cooler and intact? NO <br /> a. If YES,how many and where: I Front CY-!�S <br /> b. Were signature and date correct? (��Sj <br /> NO <br /> 2. Were custody papers taped to lid inside cooler? YES <br /> 3. Were custody papers properly filled out(ink,signed,etc)? (�D NO <br /> 4. Did you sign custody papers in the appropriate place? YES NO <br /> 5. Did you attach shipper's packing slip to this form? YES NO <br /> 6. What kind of packing material was used? Ice <br /> 7. Was sufficient ice used(if appropriate)? �S�NO <br /> S8. Were all bottles sealed in separate plastic bags? YES)NO <br /> 9. Did all bottles arrive in good condition (unbroken)? NO <br /> 10. Were all bottle labels complete (no., date,signed,pres,etc)? K_YES) NO <br /> 11. Did all bottle labels and tags agree with custody papers? , 'YES NO <br /> 12. Were correct bottles used for the test indicated? YEE NO <br /> 13. If present,were VOA vials checked for absence of air bubbles and <br /> noted if found? c7s <br /> NO <br /> 14. Adequate volume of VOA vials received per sample? NO <br /> 15. Was sufficient amount of sample sent in each bottle? NO <br /> 16. Were correct preservatives used? �T0 <br /> 17. Were extra labels added to pre-tared containers? YES <br /> 18. Corrective action taken,if necessary: <br /> ia. Name of person contacted: <br /> b. Date: <br /> m <br />