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COOLER RECEIPT CHECKLIST cb Curtis&Tompkins,Ltd. <br /> ' Login# Date Received �t Number of coolers 2 <br /> ' Client Project <br /> Date Opened By(print) Mt", (sign) <br /> Date Logged in By(print) l b (sign) <br /> 1. Did cooler come with a shipping slip(airbill,etc) YES <br /> Shipping info <br /> 2A. Were custody seals present? .... ❑YES (circle) on cooler on samples PVNO <br /> How many Name Date <br /> ' 2B. Were custody seals intact upon arrival? YES NO / <br /> 3. Were custody papers dry and intact when received? � NO <br /> 4. Were custody papers filled out properly(ink, signed,etc)? 11�� NO <br /> ' 5. Is the project identifiable from custody papers? (If so fill out top of form) NO <br /> 6. Indicate the packing in cooler: (if other, describe) <br /> Bubble Wrap ❑Foam blocks )&ags ❑None <br /> ' C1 Cloth material ❑Cardboard ❑Styrofoam ❑Paper towels <br /> 7. Temperature documentation: * Notify PM if temperature exceeds 6°C <br /> Type of ice used: 9 Wet Q Blue/Gel ❑None Temp(°C)— <br /> ' Samples received on ice& cold without a temperature blank; tette-�rlR-gnn <br /> ISamples received on ice directly from the field. Cooling process had begun <br /> ' 8. Were//Method 5035 sampling containers present? YES <br /> If YES, what time were they transferred to freezer? <br /> 9. Did all bottles arrive unbroken/unopened? NO <br /> '. 10. Are there any missing/extra samples? NO <br /> 11. Are samples in the appropriate containers for indicated tests? XM NO <br /> 12. Are sample labels present, in good condition and complete? IM NO <br /> ' 13. Do the sample labels agree with custody papers? YES <br /> 14. Was sufficient amount of sample sent for tests requested? NO <br /> 15. Are the samples appropriately preserved? �NO N/A <br /> ' 16. Did you check preservatives for all bottles for each sample? NO N/A <br /> 17. Did you document your preservative check? GS) NO N/A <br /> 18. Did you change the hold time in LIMS for unpreserved VOAs? YES NO <br /> 19. Did you change the hold time in LIMS for preserved tetracores? YES NO / <br /> 20. Are bubbles> 6mm absent in VOA samples? l� NO Nl</ <br /> 21. Was the client contacted concerning this sample delivery? YES <br /> ' If YES, Who was called? By Date: <br /> COMMENTS / <br /> f �` <br /> L r��'iS�/t���� <br /> Rev 10, 10/11 <br /> 8 of 242 <br />