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J <br /> COOLER RECEIPT FORM `J <br /> v 'Contractor Cooler <br /> LUIS/ <br /> • IIRD Cooter ! <br /> 6 Nuaber of Coolers <br /> PROJECT: <br /> r Date received- l J / <br /> L. <br /> USE OTHER SIDE OF THIS FORM TO NOTE DETAILS CONCERNING CHECK-IN PROBLEMS. <br /> v . A. ERELiMINARY EXAMINATION PHASE: Date cooler MS. FF <br /> �.. by (print) ��1 F W>✓V'i ri (sign <br /> i. Did cooler ewe with a shipping slip (air bill, ate.)? ............................................. YES <br /> If TES, enter carrier roma 9 air bill eaarber here: <br /> 6. 2. were custody seals on outside of cooler? ........................................................... YES <br /> Now many i where: seal date: , seat name <br /> V �'l <br /> 3. Were custtldy seals unbroken and intact at the data and time of arrival? ............................ TES NO _ <br /> 6. Did you screen swrples for radioactivity using the Geiger Counter................................... YES 9 <br /> S. Were custody papers seated in a plastic bag L taped inside to the tid7 ............................. YkS NO <br /> 6. Were custody papers titled out property (ink, signed, etc.)? ....................................... L MO <br /> 7. Did you sign custody papers in the appropriate piece? .............................................. O NO <br /> B. Was project identifiable from custody papers? If YES, enter project name at the top of this form. YE -No <br /> 9. If required, was enough ice used? ... Type of ice: •T�� �� ...........•• (YE NO <br /> 10. Have designated person initial here to acknowledge receipt of c ler: (date)_ <br /> y B. LOG-iN PHASE: Date samples were Logged-in: <br /> by (print) <br /> 11. Describe type of packing in cooler: <br /> V <br /> 12. Were all bottles sealed in separate plastic bags? ................................................. TES MO <br /> 13. Did all bottles arrive unbrokeni were tabels in good condition? .................................. T� No <br /> L.. <br /> 14. Were all bottle labels complete (ID, date, time, signature, preservative, etc.)? .................. TES NO <br /> 15. Did all bottle labels agree with custody papers? .................................................. ( TE NO <br /> 16. Were correct cmtalners used for the tests indicated? .............................................. YES) No <br /> 17. Were correct preservatives added to samples? .............................................. .... YES NO <br /> ►-• 10. Was a sufficient amount of ample sent for tests indicated? ....................................... No <br /> 19. Were bubbles absent in VOA smples7 If NO, list by DAN: by_f NO <br /> V 20. Was the project manager called cad status discussed? if YES, give details on the back of this form. YES NO <br /> 21. Who was called 7 By whom ? (date) <br /> 00, <br />