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Cooler Receipt Form <br /> Client -11 `%N Protect 10C. lilt <br /> Date Cooler Receive • [I'2Z^ 02 _ Date Cooler Opened <br /> Was cooler scanned for presence of radioactivity? G/No <br /> a Was radioactivity results above 25cpm? Yes/D <br /> If cooler had custody seal(s), were they signed and intact? Q�y Yes /No <br /> Was a shipper's packing slip attached to the cooler? es No <br /> Cooler was packed with Ice SL Ice Packs Bubble Wrap Styrofoam <br /> Paperer None Other <br /> Temperature of cooler- 0,10c, <br /> *Cooler needs to be received @ 4°C with an acceptable range of 2°-6°C <br /> Were all samples sealed in plastic bags? es No <br /> Did all samples arrive intact? If no, see below Yes No <br /> Were all samples labeled correctly? (ID, Dates, Tunes) If no, see below e /No <br /> Can the tests required be run with provided containers? If no, see below (QNo <br /> q <br /> Was sufficient volume of sample sent in all containers? 6DNo <br /> Were any VOA vials received with headspace? NA / Yes G <br /> Were correct preservatives used? NA Yes No <br /> *If no, see pH Log for a list of samples and container pH <br /> Any other important information <br /> Signed Date - ZZ-O Z <br />