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COOLER RECEIPT CHECKLIST Cb Curtis&Tompkins,Ltd. <br /> Login# 2 s2-�..i Date Received 1 19 1 y Number of coolers -T <br /> Client_ ea,+w r„ Project <br /> Date Opened 1114 By(print) y✓!l' (sign)_ <br /> Date Logged in b By(print) (sign) L <br /> 1. Did cooler come with a shipping slip(airbill,etc) YES <br /> Shipping info <br /> 2A. Were custody seals present? .... ❑YES (circle) on cooler on samples ANO <br /> How many Name Date <br /> 2B. Were custody seals intact upon arrival? YE NO <br /> 3. Were custody papers dry and intact when received? NO <br /> 4. Were custody papers filled out properly(ink,signed,etc)? NO <br /> 5. Is the project identifiable from custody papexs7(If so fill out top of form)_ 5 NO <br /> 6.Indicate the packing in cooler: (if other,describe) <br /> []Bubble Wrap ❑Foam blocks 21 Bags ❑None <br /> ❑Cloth material ❑Cardboard ❑Styrofoam ❑Paper towels <br /> 7. Temperature documentation: * Notify PM if temperature exceeds 6°C <br /> Type of ice used: J2r Wet ❑Blue/Gel ❑None Temp(0Q I 3 <br /> ❑ Samples Received on ice&cold without a temperature blank;temp,taken with IR gun <br /> ❑ Samples received on ice directly from the field. Cooling process had begun <br /> 8. Were Method 5035 sampling containers present? YES <br /> If Y9S,what time were they transferred to freezer? <br /> 9.Did all bottles arrive unbroken/unopened? Ifffi NO <br /> 10.Are there any missing/extra samples? YFS. <br /> 11.Are samples in the appropriate containers for mdteated tests? <br /> go <br /> 12.Are sample labels present,in good condition and complete? <br /> 13.Do the sample labels agree with custody pNO <br /> apers? <br /> 14. Was sufficient amount of sample sent for tests requested? NO <br /> 15.Are the samples appropriately preserved? NO <br /> 16.Did you check preservatives for all bottles for each sample? NO N/A <br /> 17.Did you document your preservative check? p NO N/A <br /> 18.Did you change the hold time in LIMS for unpreserved VOAs? NO N/A <br /> 19.Did you change the hold time in LIMS for preserved terracores7 YES NO . <br /> YES NO <br /> 20.Are bubbles>6rnm absent in VOA samples? <br /> 21. Was the client contacted concerning this sample delivery? NO O <br /> If YES, Who was called? i By Date: <br /> COMMENTS <br /> Rev 10; 1 in I <br /> 7 of 10 <br />