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1 i <br /> •+ J <br /> COOLER RECEIPT FORM <br /> 003ect: `\2�-\"�� Log No <br /> =ooler receive on. anid ec e onAsj <br /> Y <br /> Aaure <br /> dere custody papers present' . . . . . . . . . . . . . . . . . . . . . . . . . yza NO <br /> dere custody papers properly filled out' . . . . . . . . . . . . . . . . . ..Y-Es NO <br /> dere the custody papers sjgned'' . . . . . . . . . . . . . . . . . . . . . . . . . .�*" NO <br /> las sufficient ice used" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . —Vz-s' NO -, i N . <br /> Did all bottles arrive in good condition (unbroken) ? . . . . . . . YES NO <br /> Did bottle labels match COC? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . }E-E,-� NO <br /> Were proper bottles used for analysis indicated' . . . . . . . . . . Y-LS NO <br /> Correct preservatives used' . . . . . . . . . . . . . . . . . . . . . . . . . . .'fE-S- NO <br /> VOA vials checked for headspace bubbles? . . . . . . . . . . . . . . . Y£-& NO <br /> Note which voas ( if any) had bubbles: * <br /> Sa ple descriptor : Number at vials <br /> 1 . <br /> *All VOAs with headspace bubbles have been set aside so they will not be <br /> used for analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YES NO <br /> List here all other fobs received in the same cooler: <br /> Client Job # NET log # <br /> (coolerrec) <br />