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a ' <br /> Cooler Receipt Form <br /> Client: n Project <br /> Date Cooler R eived. ::-1 14 Jo-3 Date Cooler Opened. s 3 <br /> Was cooler scanned for presence of radioactivity? No <br /> a: Was radioactivity results above 25epm? /No <br /> If cooler had custody seal(s), were they signed and intact? Yes/No <br /> C7 <br /> Was a shipper's packing slip attached to the cooler? Yes / E) <br /> Cooler was packed with: Ice Y_Ice Packs BubbleWrag Styrofaam <br /> Paper None Other <br /> Temperature of cooler: © �- G <br /> *Cooler needs to be received @ 4°C with an acceptable range of 2°-6°C <br /> Were all samples sealed m plastic bags? yes(s) <br /> Did all samples arrive intact? If no, see below JN <br /> Were all samples labeled correctly (ID, Dates, Tunes) If no, see b <br /> Can the tests required be run with provided contazners`� If no, see bWas sufficient volume of sample sent in all containers?Were any VOA vials received with headspace? o <br /> Were correct preservatives used? I Yes /No <br /> *If no, see pH Log for a list of samples and container pH <br /> Any other Important information: <br /> 14 <br /> Signed 6,4A Date: , <br />