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1 <br /> 1'aee: f Oi 1cb <br /> LC <br /> Effective Dare: 10-TNI av-QC+ <br /> Revision: i dumber 3 o <br /> �,J f Filename: F:',:QC'-,Forn,s',QC'Cooler.%k,pd <br /> COOLER RECEIPT CHECKLIST x <br /> i L k <br /> Login#: I)alc fteceiveci: (2- ---- umber of'Coolers: <br /> L Client: LA 5 _ Proiect: -- <br /> A. Preliminary Examination Phase (f <br /> Z�1 B (print.):- `� k (sign) <br /> i <br /> Date Opened: y (p fit' �Ll ' l «--- <br /> I 1. Did cooler come with a shipping slip (airbiil, etc.)''...........,............... , <br /> LIf YES, enter carrier name and airbill numl ev Ear, rt{ .d <br /> 2. Were custody seals on outside of cooler?.............................................I....... <br /> .... "E C <br /> How many and where? Seal date: Seal name: <br /> 3. Were custody seals unbroken and intact ar she date and time of arrival'?........... 1'E NO 'v <br /> 4. Were custody papers dry and intact when received'?.................. _S 'v0 <br /> 5. Were custody papers filled out properly (ink. signed. etc.)",.....,........... ....... <br /> tc.)",......................... NO <br /> 6. Did you sign the custody papers in the appropriate place?................................ NO <br /> 7. Was project identifiable from custody papers'......,............... <br /> If YES, enter project name at the top of this form. <br /> i <br /> ' 8. If required, was sufficient is_ used? Samples should be 2-6 degrees C. ........... E . NO <br /> Type of ice: �' Tem <br /> Yp p,.,rature:_ SrZ SO(— <br /> B. <br /> `LB. Login Phase <br /> h <br /> � r 1 <br /> Date Logged In: ��-�l By (print):T <br /> 1. Describe type of packing in cooler: <br /> 2. Did all bottles arrive Unbroken?....................................................................... NO <br /> 3. Were labels in good condition and complete (ID, date, time, signature, etc.)?... NO <br /> 4. Did bottle labels agree with custody paper:,?............. .. ... N0 <br /> 5. Were appropriate containers used for the tests indicated?................................. MNO , <br /> - 6. Were correct preservatives added to samples?.................................................. NO <br /> 7 . Was sufficient amount of sample sent for tests indicated?...6............. <br /> 8. Were bubbles absent in VOA samples? If NO, list sample Ids below................ S NO <br /> 9. Was the client contacted concerning this sample delivery?........................ ....... YES NO <br /> If YES, give details below. <br /> Who was called? By whore" Date: <br /> �. Additional Comments: <br /> , <br /> i <br /> F>Iename: F lgclformslcooler.wpd Rev. 4i55 <br />