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TEST AMERICAS INC.-NASHVILLE <br /> COOLER RECEIPT FORM <br /> Client: scwfc BOY J336Z <br /> Cooler Received And opened On--_Z spy:• Mike Mebride <br /> itiA-l�ll("�' <br /> (Signature) ? <br /> i. Temperature of Cooler when opened Degrees Celsius <br /> 2. Were custody seals on outside of cooler and Intact?.................................... 70 <br /> a. If yes,what kind and where: 0 ON ACKISIDE <br /> b. Wets the signature and date correct?........................................... <br /> �PiO <br /> V- We"cmtody aeab on contadnen and tntmW.......................................YES® <br /> 3. Were custody papers made cookotrl........................................................... O <br /> 4. Were custody papers properly fad ons(in 94Pedretc)?.............................,0�0 <br /> s. Did you sign the custody papers in the UPPmPrIate Place?........................—4. 0 <br /> 6. What kind of packing mates ��RMiCCri—ITIS NONE <br /> Dim <br /> 7. Was sufficient ice used(if appropriate)?...................................................�`0 <br /> L Did all bottles arrive in good condition(unbroken)?...................................eFoo <br /> s. Were an bottle labels complete (4,dateAgned pies,etc)?...............................(9�ro <br /> m Did an bottle labels and tags agree with m-tody papers?............................... E5 0 <br /> 11. We"correct bottles used and present for the analysis requested?...............�o <br /> 12. Were VOA vuh presema........................................................................... YES® <br /> a.1f so were s1r babbles prment?............................................................ .. <br /> 13. Was sufficient a=unt of sample sent in each bottle?................................ . E�0 <br /> 1a. Were correct preservatives used?............................................................ ..margo <br /> 15. Was r midnal chlorine present?..................................................:......... <br /> 16. Corrective action taken,ti necessary: <br /> a. Name of person contacted: <br /> b, Date: <br /> Cooler Recut Form LF-1 1 Q/Sl99 <br />