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COOLER RECEIPT CHECKLIST <br /> Cb Curtis&Tompkins,Ltd, <br /> Login# 25 -4-vie �l <br /> Client eDate Received 11.101y Ny Number of coolers 3 <br /> A�A, r„w Project Z." -2w2.p <br /> Date Opened 91x9 By(print) t y✓!l (sign)_ <br /> Date Logged in b By(print) :L <br /> (sign) g <br /> 1. Did cooler come with a shipping slip(airbill, etc) —YES Shipping info <br /> 2A. Were custody seals present? ❑YES (circle) on coo'le'r . on samples �3NO <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 papers? (If so fill out top of form)_ S NO <br /> 6.Indicate the packing in cooler: (if other, describe) <br /> ❑Bubble Wrap ❑Foam blocks AJ 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: J'Wet ❑Blue/Gel E]None Temp(IC) <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 YE`S, what time were they transferred to freezer? <br /> 9.Did all bottles arrive unbroken/unopened7 IfR.S <br /> 10.Are there any missing/extra samples? NO NO <br /> 11. Are samples in the appropriate containers for indicated tests? 0 <br /> 12.Are sample labels present,in good condition and complete? NO <br /> 13.Do the sample labels agree with custody papers? NO <br /> 14. Was sufficient amount of sample sent for tests requested?_ NO <br /> 15. Are the samples appropriately preserved? NO N/A <br /> 16. Did you check preservatives for all bottles for each sample? NO N/A <br /> 17.Did you document your preservative check? NO N/A <br /> 18. Did you change the hold time in LIMS for unpreserved VOAs? YES NO . <br /> 19.Did you change the hold time in LIMS for preserved terracores? YES NO <br /> 20. Are bubbles> 6mm absent in VOA samples?- N <br /> 21. Was the client contacted concerning this sample delivery? YES O <br /> If YES, Who was called? + By Date: <br /> COMMENTS <br /> Rev 10, 11/11 <br /> 6 of 121 <br />