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'TestAmerical <br /> _ _ ANALYTfCAL 7E5 TING C00.P00.ATiON I <br /> Nashvtlle Division <br /> COOLER RECEIPT FORM BCP 34 � I <br /> //-- 7452 <br /> Client C:> 1 T CllClI n e , r-)C <br /> Cooler Received On 9/19/03And Opened On 9/19/03By Shane Gambill <br /> (Signature) <br /> I Temperature of Cooler when opened j De,2rees_Celsius <br /> 1 2 Were custody seals on outside of cooler's YES "O "N'1 <br /> a It yes, how many,what kind and where 1/2/3/4 FRONT/BACK/SIDE <br /> 3 Were custody seals on containers and intact' ;v0 YES ( .�) <br /> 4 Were the seals intact, signed, and dated correctly" YES NO N %, <br />' 5 Were custody papers inside cooler' e!iE:SD NO NA <br />'• 6 Were custody papers properly filled out (tnk,signed,etc)`' YES NO v_11L <br /> 7 Did you sign the custody papers in the appropriate place' YE NO :SA <br />' 3 What kind of packing material used Bubbkewra Peanuts Vermiculite Other None <br /> 9 Cooking process ce Ice pack Ice(direct contact) Dry ice Other ?done <br /> t to Did all,containers arrive in goad condition( unbroken) (Ts <br /> `E�, NIn INA <br /> 11 Were all container labels complete (4 date,signed,pres,etc)9 YES NO N NL <br />' 12 Did all container labels and tags agree with custody papers" t (YE)NO NA <br />' 13 Were correct containers used for the analvsis requested' rES 'v0 N k <br /> 14 a Were VOA vials received" YES NO NA <br />' b Was there any observable head space present in any VOA vial' VO , YDS <br /> 15 Was sufficient amount of sample sent in each container) YES v0 N SL <br />' lb Were correct presprvatrves used YEsS '110 N <br /> If not record standard ID of preservative used here <br />' 1" Was residual chlorine present' NO N Els N o <br /> 18 See attached for resolution of non-conformance <br /> i <br /> ' Fed-Ex UPS Velocity \irborne Route Ott-street MISL <br /> ' C`nn1Pr T = i n „� <br />