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COOLER RECEIPT CHECKLIST ,cb Curtis&Tompkins,Ltd. <br /> Login# Z 1016 Date Received Number of coolers_ <br /> Client 1--7 E:,- Project C,14 wG — <br /> Date Opened / -19—(0 By(print) s•�? � (si <br /> Date Logged in_ By(print) <br /> 1. Did cooler come with a shipping slip (airbill, etc) YE1� <br /> Shipping info <br /> 2A. Were custody seals present? ._. ❑YES (circle) on cooler on sampjYES <br /> O <br /> How many Name Date <br /> 2B. Were custody seals intact upon arrival? O /A <br /> 3. Were custody papers dry and intact when received? O <br /> 4. Were custody papers filled out properly(ink, signed, etc)? O <br /> 5. Isthe project identifiable from custody papers?(If so fill out top of form) r-YUS NO <br /> 6. Indicate the packing in cooler: (if other,describe) <br /> 2bble Wrap ❑Foam blocks "�ags ❑None <br /> ❑Cloth material El Cardboard E]Styrofoam ❑Paper towels <br /> 7. Temperature documentation: <br /> Type of ice used: Wet Q Blue/Gel ❑None Temp(OC) <br /> >9MRIes Received on ice&cold without a temperature blank <br /> ❑ Samples received on ice directly from the field. Cooling process had begun <br /> 8. Were Method 5035 sampling containers present? YES-(a) <br /> If YES,what time were they transferred to freezer? <br /> 9. Did all bottles arrive unbroken/unopened? S NO <br /> 10. Are samples in the appropriate containers'for indicated tests? NO <br /> 11.Are sample labels present, in good condition and complete? NO <br /> 12. Do the sample labels agree with custody papers? YE NO <br /> 13. Was sufficient amount of sample sent for tests requested? NO <br /> 14. Are the samples appropriately preserved? YE <br /> 15. Are bubbles>6mm absent in VOA samples? YES N <br /> 16. Was the client contacted concerning this sample delivery? YES NO <br /> If YES,Who was called? By Date: <br /> COMMENTS <br /> SOP Volume: Client Services Rev.6 Number 1 of 3 <br /> Section: 1.1.2 Effective:23 July 2008 <br /> Page: 1 of 1 Z:\gc\forms\checklists\Cooler Receipt Checklist rv6.doc <br /> 5 of 63 <br />