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16a <br /> 5011 vel-,i-,:r11L!: :��nl <br /> Section .2 <br /> Wage: I of I <br /> Effective Date: 10-May-99 <br /> Revision: I Number 31 of <br /> I.. Filename: F:IQC",Foriiis',QC'Cot)ier.wpd <br /> COOLER REMPT CHECKLIST <br /> Loging. Dai:- Received: 11. Nuinber of Coolers: <br /> Client. 1 ,4 fp a Pro-ject:::: ✓ LA <br /> A. Preliminary Examination Phase <br /> twe Date Opened: �r By (print): <br /> (sign) <br /> 1. Did cooler come with'a shipping slip (airbill. etc.)?........(V—.........\......... ........ ES NO <br /> If YES, enter carrier name and airbill numf 2. T)w <br /> Were custody seals on outside of cooler?........... .......I.......... <br /> How many and where? Sea] date- Seat name: <br /> 3. Were custody seals unbroken and intact at Lhe daze and time of arrival?—.....— YES NC <br /> 4. Were custody papers dry and intact when received'?......................................... NO <br /> 5. Were custody papers filled out property (ink. signed. etc.)')...............................PT N <br /> 6. Did you sign the custody papers in the appropriate place?...................... NO <br /> 7. Was project identifiable from custody papers?.................................................. NO <br /> If YES, enter project name at the top of this form. <br /> 8. If required, was sufficient i d? Samples should be 2-6 degrees C. .......... S NO <br /> Type of ice- Temperature: V(— <br /> B. Login Phase <br /> Date Logged In: By (print): I <br /> I Describe type of packing in cooler: —6A,-� C-- \J <br /> 2. Did all bottles arrive,unbroken?........................................................................ . NO <br /> 3. Were labels in good condition and complete OD. date, time, signature, etc.)?.. NO <br /> 4. Did bottle labels agree with custody paper,.................­........*..........*....­......* �ft�NO <br /> 5. Were appropriate containers used for the tests indicated?................................. Y5f NO <br /> 6. Were correct preservatives added to samples?.................................................. NO <br /> 7 Was sufficient amount of sample sent for tests indicated?................................. VZ'Q NO <br /> 8. Were bubbles absent in VOA samples? If NO, ]list sample Ids below.................19S NO <br /> 9. Was the client contacted concerning this sample delivery?................................ YES NO <br /> If YES, give details below. <br /> Who was called? By ",.hom? Date: <br /> Additional Comments: <br /> Filename: F:kqckformslcoolermpd Rev 1, <br />