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COOLER RECEIPT CHECKLIST cb CLirtis&Tompkins, Ltd. <br /> Login# 2`� 7r� Date Received z 1 Number of coolers <br /> Client Project <br /> Date Opened 5-/r--`�l By (print) (sign) ` <br /> Date Logged in By(print) , (sign) <br /> Y 50 <br /> 1. Did cooler come with a shipping slip (airbill, etc) YESTO <br /> Shipping info <br /> 2A. Were custody seals present? .... ❑YES (circle) on cooler on samples 2-NO <br /> How many Name Date <br /> 2B. Were custody seals intact upon arrival? Y NO k�D <br /> 3. Were custody papers dry and intact when received? YE NO <br /> 4. Were custody papers filled out properly(ink, signed, etc)? E NO <br /> 5. Is the project identifiable from custody papers? (If so fill out top of form) 1, SS NO <br /> 6. Indicate the packing in cooler: (if other, describe) <br /> ❑Bubble Wrap ❑Foam blocks ❑Bags ❑None <br /> ❑Cloth material hardboard ❑Styrofoam ❑Paper towels <br /> 7. Temperature documentation: * Notify PM if temperature exceeds 6°C <br /> Type of ice used: ❑ Wet ❑Blue/Gel done Temp(°C) <br /> ❑ Samples Received on ice & cold without a temperature blank; temp. taken with IR gun <br /> ❑ Samples received on ice directly from the field. Cooling process had begun <br /> 8. Were Method 5035 sampling containers present? YES 10 <br /> If YES, what time were they transferred to freezer? <br /> 9. Did all bottles arrive unbroken/unopened? `AYE NO <br /> 10. Are there any missing/extra samples? YES ZSO <br /> 11. Are samples in the appropriate containers for indicated tests? O <br /> 12. Are sample labels present, in good condition and complete? NO <br /> 13. Do the sample labels agree with custody papers? T <br /> 14. Was sufficient amount of sample sent for tests requested? E <br /> 15. Are the samples appropriately preserved? YES NO N1/ <br /> 16. Did you check preservatives for all bottles for each sample? YES NO / <br /> 17. Did you document your preservative check? YES NO / <br /> 18. Did you change the hold time in LIMS for unpreserved VOAs? YES NO Iq <br /> 19. Did you change the hold time in LIMS for preserved terracores? YES NO NI <br /> 20. Are bubbles> 6mm absent in VOA samples? YES NO N/ <br /> 21. Was the client contacted concerning this sample delivery? YES 5D <br /> If YES, Who was called? By Date: <br /> COMMENTS � e <br /> 13. CSV 12.- fV r- <br /> n 0� « 1�V� J c- S:V` <br /> Rev 10, 11/11 <br />