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TEST AMERICA ANALYTICAL i <br /> TESTING CORP.-NASHVILLE <br /> COOLER RECEIPT FORM B <br />' 333872 <br /> Client <br />' Cooler Received On: 5130103 And Opened On. 5130/03 By: Marvin Biunihoefer <br /> (Signature) <br /> I. Temperature of Cooler when opened _0- e De rees Celsius <br /> 2 Were custody seals on outside of cooler' .. . . . . . . YES NO . NA <br /> a. If yes, how many,what kind and where• L f <br /> 3. Were custody seals on containers and intact .. . . . . . .. . .. .. .. YES . NA <br />' 4. Were the seals intact, signed, and dated correctly? .YES .NO .CA <br /> 5. Were custody papers inside cooler?. ... .. . . . . . . . . ,Si NO . NA <br />' 6. Were custody papers properly filled out (ink,signed,etc)? . YOGILNO NA <br /> 7. Did you sign the custody papers in the appropriate place' ... ..T(S NO NA <br /> S. What kind of packing material used. Bubblewrap Peanuts Vermiculite Other None <br /> . ... <br /> 9 Was sufficient ice used (if appropriate). .. S NO NA <br /> I <br /> 10 Did all bottles arrive in good condition( unbroken)? ... ,. .. ES. NO . NA <br /> 11 Were all bottle labels complete (#,date,signed,pres,etc)? NO NA <br /> 12. Did all bottle labels and tags agree with custody papers? . . S. :NO NA <br /> 13 Were correct bottles used for the analysis requested' ... .. . .. S.. NO . NA <br /> 14 a. Were VOA vials received?.. . . NO . NA <br /> b Was there any observable head space present in any VOA vial`' YES NA <br /> 15. Was sufficient amount of sample sent in each bottle9 O . NA <br /> 16 Were correct preservatives used? .. . . . . S ; NO NA <br />' If not, record standard ID of preservative used here <br /> 17 Was residual chlorine presents .. .. .NO . YES <br /> 18._5ee-attached for resolution of non-conformance <br /> i <br />' Fed-Ex UPS Velocity Airborne Route Off-street Misc. <br /> Cooler Receipt Form LF-1 3!6103 <br />