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1 s <br /> TestAmerlca <br /> ANALYTICAL TESi1NG C08P0&ATION <br /> Nashville Division <br />' COOLER RECEIPT FORM BC# <br /> 391449 <br />' Client Name ETIC Engineering <br /> Cooler Received/Opened On: 1011104 Accessioned By: James A Jacobs <br /> C)G,2�_ <br /> Log-in Pero el Signature <br /> 1. Temperature of Cooler when triaged S.'Degrees Celsius <br /> 2 Were custody seals on outside of cooler? .. YES NO NA <br /> a. If yes,how many,what kind and wherer: <br /> 3 Were custody seals on containers and intact' . . . . NO YES NA <br /> 4. Were the seals intact,signed,and dated correctly9E NO NA <br /> y <br />' S Were custody papers inside coolers YE NO NA <br /> 6 Were custody papers properly filled out(ink,signed,etc)' E NO NA <br /> 7 Did you sign the custody papers in the appropriate place? .. NO NA <br /> 8 What land of packing material used Bubble ap Peanuts Vermiculite Other None <br /> 9 Cooling process Ice Ice-pack lee(direct contact) Dry ice Other None <br /> 10 Did all containers arrive in good condition(unbroken)P NO NA <br /> 11 Were all container labels complete(#,date,signed,pres,etc) E� NO NA <br /> 12 Did all container labels and tags agree with custody papers' .. 'E NO NA <br />' 13 Were correct containers used for the analysis requested9 NO NA <br /> 14 a. Were VOA vials received? NO NA <br /> b Was there any observable head space present in any VOA vial'? [NO,! YES NA <br /> 15 Was sufficient amount of sample sent in each container? ��'E NO NA <br /> 16 Were correct preservatives used? NO NA <br /> If not,record standard ID of preservative used here r�� <br /> 17 Was residual chlorine present9 NO YES NA <br /> 18 Indicate the Airbill Tracking Number(last 4 digits for Fedex only)and Name of Courier below <br /> 7334 <br /> UPS Velocity Airborne Route Off-street Misc <br /> 19 If a Non-Conformance exists,see attached or comments below <br /> Cooler Receipt Form LF-1 Revised 313144 <br />