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COOLER RECEIPT CHECKLIST Cb Curtis&Tompkins,Ltd. <br /> Login# 253't 1'4' Date Received Number of coolers <br /> ' Client %; g., Project <br /> Date Opened X11g By(print) (sign) 17 <br /> ' Date Logged ins By(print)________j__(sign) t <br /> 1. Did cooler come with a shipping slip (airbill, etc) YESN o <br /> ' Shipping info <br /> 2A. Were custody seals present? .... EYES (circle) Co-n-coolD on samples - NO <br /> ' How many a, Name Date Ili w 1d <br /> 2B. Were custody seals intact upon arrival? NO f 42�, <br /> 3. Were custody papers dry and intact when received. NO <br /> 4. Were custody papers filled out properly(ink, signed, etc)? S NO <br /> 5. Is the project identifiable from custody papers? (If so fill out top of form)_ NO <br /> 6. Indicate the packing in cooler: (if other, describe) <br /> 0 Bubble Wrap ❑Foam blocks ffBags ❑None <br /> ❑Cloth material ❑Cardboard ❑Styrofoam ❑Paper towels <br /> 7. Temperature documentation: *Notify PM if temperature exceeds 6*C <br /> Type of ice used: -,T�Wet ❑Blue/Gel ❑None Temp(°C) L, s <br /> ❑ Samples Received on ice & cold without a temperature blank; temp. taken with IR gun <br /> ' 19 Samples received on ice directly from the field. Cooling process had begun <br /> 8. Were Method 5035 sampling containers present? YESVO <br /> If YE+S, what time were they transferred to freezer? <br /> 9. Did all bottles arrive unbroken/unopened? NO <br /> 10. Are there any missing/extra samples? TVs 496 <br /> ' 1 I. Are samples in the appropriate containers for indicated tests? NO <br /> 12. Are sample labels present, in good condition and complete? NO <br /> 13. Do the sample labels agree with custody papers? NO <br /> ' 14. Was sufficient amount of sample sent for tests requested? NO <br /> 15. Are the samples appropriately preserved? NO N/A <br /> 16. Did you check preservatives for all bottles for each sample? NO N/A <br /> ' 17. Did you document your preservative check? NO N/A <br /> 18. Did you change the hold time in LIMS for unpreserved VOAs? YES NO <br /> 19. Did you change the hold time in LIMS for preserved terracores? YE NO <br /> 60 <br /> ' 20. Are bubbles> 6mm absent in VOA samples? YES;NO N/A <br /> 21. Was the client contacted concerning this sample delivery? YE <br /> ' <br /> If YES, Who was called? - O BY Date: <br /> COMMENTS <br /> ' Rev 10, 1Ini <br /> Qr%fR <br />