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COOLER RECEIPT FORM d <br /> 11ject: 5- Z - Log No DO <br />'ooler receive on: andhecked on by <br /> s zgna ure <br /> sere custody papers present . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Y-£8' NO <br /> Jere custody papers properly filled out? . . . . . . . . . . . . . _ . .M-BE- NO <br /> sere the custody papers signed? . . . . . . . . . . . . . . . . . . . . . .Y--LxS NO <br /> a <br /> sas sufficient ice used' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . yj:�ff NO <br />)id all bottles arrive in good condition (unbroken) ' . . . . . . . NO <br /> aid bottle labels match CDC? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YES NO <br /> Gere proper bottles used for analysis indicated? . . . . . . . . . . .YES NO <br /> Sorrect preservatives used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Y-Frfi- NO <br /> VOA vials checked for headspace bubbles? . . . . . . . . . . . . . . . . . . YrS NO <br /> Note which voas (if any) had bubbles: * <br /> SaAple descriptor: Number of vials <br /> AOL <br /> v� <br /> v.1 - <br /> *All VOAs with headspace bubbles have been set aside so they will not be <br /> usedfor analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO <br />.List here all other Sobs received in the same cooler: <br /> (coolerrec) <br />