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,i <br /> .�I <br /> SCUio1r: .I.i I <br /> Effective Date: 10 ;V9av-99 cb <br /> v <br /> Re rsion: i V urYrb•r <br /> � of_ <br /> R� Filename: F:IQCIForrris1QU1Coo1er.,vpd <br /> C010LER R CEIFF CHECKLIST' <br /> I� <br /> Login#: 2 q(.29* [)ate Received: 6/23 160-- 'viUtImberofCoolers: <br /> Client: 00; 6Me-1ME1L>_ Project: _IUD -- <br /> -- <br /> A. Preliminary Examination Phase <br /> Date Opened: /,73Zoo By (print): [QAVE-25 (sign) <br /> 1. Did cooler come with a shipping slip (airbill, etc.)''.......!......... ......................... NO <br /> If YES, enter carrier name and airbill numt er.- ~' <br /> 2. Were custody seals on outside of cooler?................. 11 ........ YES <br /> How many and where? Seal date: it Seal narne: <br /> 3. Were custody seals unbroken and intact ar the date and time of arrival?..........w E <br /> 4. Were custody papers dry and intact when received?.......Y...........:...................... (ZD NO <br /> 5. Were custody papers filled of properly (ink. signed, etc.}?1..........................111 (�NO l <br /> 6. Did you sign the custody papers in the appropriate place.......I......................... * 9 NO <br /> 7. Was project identifiable from custody papers?...............! ........:.......I..............-- ANO <br /> If YES, enter-project name at the top of this form. li <br /> 8. If required, was sufficient ic- used? Samples should be 2-6 degrees C. .......... YES , <br /> Type of ice: W E1— _ Temperature:' o L <br /> B. Login Phase <br /> Date Logged In:6123100 By (print): . (sign) 12 t n a_j <br /> I. Describe type of packing in cooler: eE II <br /> bottles2, Did all <br /> ..� <br /> 3. Were labelsin od conditionlnd complete (11), date, <br /> . time,e, st <br /> gnature, etc.)?... NO <br /> 4. Did bottle labels agree with custodypapen,", .........11. .1.1..... 417-M5. Were appropriate containers used for <br /> I <br /> he tests indicated?............................. <br /> FS t 'O 1 <br /> 6. Were correctsam reservatives added to les?................. .......:....................... 1�0 <br /> p P <br /> 7 . Was sufficient amount of sample sent for tests indicated?................................. ES N0 <br /> 8. Were bubbles absent in VOA samples? If NO, list sample p e Ids below................. = N <br /> g P r <br /> 9. Was the client contacted concernin this sample delivery",?.. �' ,5 0_ <br /> If YES, give details below. <br /> Who was called? By who? IE Date: <br /> I� <br /> Additional Comments: i+ <br /> II4 :r 1 <br /> Filename: FagcVormslcooler.wpd ------ Rev. <br /> t li � <br />