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1 <br /> COOLER RECEIPT FORM <br /> rokct: Log No: 1 <br /> ooler receive on: and checked on `1 by <br /> j sia ure <br /> ere custody papers present? . . . . . . . . . . . . . . . . . . . . . . . . . . . .AIE5' NO <br /> ere custody papers properly filled out? . . . . . . . . . . . . . . . . . . .4-E37 NO <br /> ere the custody papers signed' . . . . . . . . . . . . . . . . . . . . . . . . . . .YES- NO <br /> assufficient ice used' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Y-Ls NO <br /> id all bottles arrive in good condition (unbroken) ' . . . . . . ..: E NO <br /> yid bottle labels match COC? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YES NO <br /> sere proper bottles used for analysis indicated' . . . . . . . . . . . Y-.r NO <br />'orrect preservatives used? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Y-£SS NO <br /> IOA vials checked for headspace bubbles' . . . . . . . . . . . . . . • • • •YES, NO <br /> Note which voas ( if any) had bubbles: * <br />,ample descriptor: Num�—r of vials: <br /> W^ <br />*All VOAs with headspace bubbles have been set aside so they will not be <br /> usedfor analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO <br /> List here all other fobs received in the same cooler: <br /> 1e�1t Job # - NET <br /> •S, <br /> . (coolerrec) <br />