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COOLER RECEIPT FORM <br /> ect: t <br /> Log No: <br /> ler receive on: and cnecked onby <br /> Signa u e <br /> mere custody papers present> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TE�s NO <br /> 4ere custody papers properly filled out? . . . . . . . . . . . . . . . . . . .YES NO <br /> Were the custody papers signed> . . . . . . . . . . . . . . . . . . . . . . . . . . . .yxk& NO <br /> Was sufficient ice used? . . . . . . . . . . . <br /> Did all bottles arrive in good condition (unbroken) ? . . . . . . .*95 NO <br /> Did bottle labels match CDC? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-&8 NO <br /> were proper bottles used for analysis indicated? . . . . . . . . . . .YF6& NO <br /> Correctpreservatives used? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Y.F& NO <br /> VOA vials checked for headspace bubbles? . . . . . . . . . . . . . . . . .1LB& NO <br /> Note which voas (if any) had bubbles: * <br /> Sample descriptor: Number of vials: <br />*All VOAs with heads ace bubbles have been set aside so the will not be <br /> P Y <br /> used for analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YES NO <br /> List here all other Sobs received in the same cooler: <br /> Client Job # _ NET log <br /> (coolerrec) <br />