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ENVIRONMENTAL CHEMICAL CORPORATION <br /> COOLER RECEIPT FORM <br /> Cooley#: <br /> Project: CG <br /> A. PRELIMINARY EXAMINATION PHASE: Date cooler was opened: �- <br /> By: (Print) Becky Boris <br /> 1. Were custody seals on outside of cooler?......... YES NO <br /> If yes, how many and where? <br /> Date Signature <br /> 2. Were custody seals unbroken and intact at the date and time of arrival?........... YESNO <br /> 2a. Were tamper-evident seals used?...............................................................:...... YES O <br /> 3. Were chain of custody papers sealed in a plastic bag and taped to top of lid? IXS NO <br /> 4. Was project identifiable from custody papers?.................................................. *S NO <br /> 5. Were custody paper filled out properly(ink, signed, ect)?................................ IXS NO <br /> 6. Did you sign custody papers in the appropriate place?...................................... Y�kS NO <br /> 7. Did cooler come with a shipping slip?............................................................... AS NO <br /> If yes, attach&enter airbill0;-( <br /> B. PACKAGING PHASE: <br /> 8. Describe Packaging: Ice Packs Peanuts -Icy aal <br /> 9. Was enough ice used?........................... p �C <br /> ......................Tem . S NO <br /> 10. Were all bottles sealed in separate plastic bags and in good condition?........ N�S NO <br /> 11. Were bottle labels and correct containers used?........................................... YT�S NO <br /> 12. Did labels agree with custody papers?.......................................................... 1'Y4,S NO <br /> 13. Were correct preservatives used when required?.......................................... <br /> 14. Was correct amount of sample sent for analysis?.......................................... U\S NO <br /> 15. Designated person initial here to acknowledge receipt of cooler: '* Date: <br />