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COOLER RECEIPT FORM <br /> c.. M <br /> ect: Z5$' 0 /4v SQ a 20 s C41 Log by: <br /> ler receive on: a-j(o- an c ec a on 2-16,- Y <br /> Signa r <br /> Were custody papers present? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> NO <br /> Were custody papers properly filled out? . . . . . . . . . . <br /> . . . . . . . . QS NO <br /> Were the custody papers signed' . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> yES, NO <br /> Was sufficient ice used" .1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> YES NO <br /> Did all bottles arrive in good condition (unbroken) ? . . . . . . .YES NO <br /> Did bottle labels match COC? . . . . . . . . . . . • • - - - • • • • • • NO <br /> . . ' : � <br /> Were proper bottles used for analysis indicated? . . . . . . . . ES NO <br /> �f E <br /> Correct preservatives used • <br /> . . . . . . . . . . . . . . . . • • - • • • • • • • • • . NO <br /> `-✓ <br /> VOA vials checked for headspace bubbles? . . YES NO <br /> Note which voas ( if any) had bubbles: * <br /> Sample descriptor - <br /> Number of vials : <br /> i <br /> /i-f <br /> *All VOAs with headspace bubbles have been set aside so �they ESill not be <br /> used for analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> List here all other Dobs received in the same cooler: <br /> Client Job # NET log # <br /> (coolerrec) <br />