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r <br /> • COOLER RECEIPT FORM <br /> ClientV4LSeCA M env j w-,e Project —Thr'NHY 17Z <br /> Cooler Received 0) Cooler Opened 5-11-01 By v <br /> Sinned <br /> Was cooler scanned for presense of radioactivity and noted if found? No <br /> Were custody seals present on outside of cooler" Yes <br /> a If Yes x\ere they intact9 Yes No <br /> b How man\ and «here? <br /> c Were signature and date correct9 Yes No <br /> Were custod\ papers included %Kith the samples' No <br /> Were the custod\ papers completer filled out' QL <br /> No <br /> Did jou sign and date the custody papers in the appropriate place" <br /> 67C C 0 <br /> Was a shipper packing slip attached to the c000ler' o <br /> . What Lind of packing material gas used" 9 -p � �J <br /> Was sufficient ice used" Yes Temperature of cooler" 2.0.;� <br /> Approved b,� Date 5-t 1--Q <br /> Were all bottles se d in seperate plastic bags" Yes <br /> Did all bottles arrne intact" Ye No <br /> Were all bottles labled correctly" (ID Ana11 sis Dates Times) G'e� No <br /> Did all ID's match the custody paperwork" � No <br /> Were the correct containers included for the tests required" (141-s No <br /> Were all VO A y ials checked for headspace? NIA No <br /> Was sufficient volume of sample sent in all containers" �s No <br /> Were correct preservatives used No <br /> Approved by Date <br /> If not approved <br /> a Nance of person contacte Date <br /> b Corrective action taken <br />