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TEST A UMCAi INC.-NASHVILLE <br /> COOLER RECEIPT FORM <br /> ' cum. T-tq>e- <br /> Cooler Recaefvea On:717 z And Opened on:"7YTrxSy: Mke MCbridB <br /> i. Temp=tm of C iDole'when upenea_ a Degreess Celsius <br /> Z. Weems custody seals on outside of caaler and infact$............ <br /> a. it yes,what kind and whem A _�ACI J/ME <br /> b. dpxtmm md date m•.dA^/ xa <br /> r Wem mob on cgutubms and Y <br /> Were cufftody papas hudde i'oQ ..............,...eaul.ua....1...........\\.4. r....r....��u <br /> Wom cu&Ddyr`•pe'"g pro DEii p*--O.'__ pek)!.............................499N\I <br /> ' 6 What bund of gackft ma <br /> r• Was Nuffidmt ics uffea c�� Priate)?...................... ...................... <br /> • <br /> IL Did&.JY�ar� good \ • �.}�� <br /> in LVW .....•..i.\{.\{.JYll.il..1..••..\\ � <br /> ' 9. W�man WfflY f.. tb coWiYW(#,dR 4`^e_rek)I................•............ V <br /> m M aH boftlabek and tqp aVu with c"" od papers?.....m►\\•r.r•.rri.r.rnr•nf"'•"f^�' <br /> il. Were correct bottles used and present for tM aD*'U requeSt4'd?•.•YY..........: `F <br /> ' <br /> ?.........J............. <br /> 12. Wen�A'4�i p'TBsi� - <br /> A_][fgo wen WWNW ?......... <br /> ..il.►.i..\.►.a.\..Ii...\{i..J\.1J.1.....\ii..1{{.1{..1\4• <br /> ' f3. Wag MMCjMt asaoant of nm'q a sent in eaehlotf e?.....,:....a...,1.,.....a.......�V ' <br /> tives used?..........................................:....................\.�Vi'4d <br /> ' 1�, Weare correctgreserva . <br /> !S. Was residual chlarrne prsent`t.................l..........................\.....:...,.....Pi8'Yl <br /> I6. Corrective action taken,If neeessary: <br /> a <br /> rjjmx of peon contacted, <br /> U Dater._ <br /> Gaoler R.eceig#Forpu <br /> LF-1 iQ1511'9 <br />