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t - F ,fir , - _ • . - y� Y <br /> .G <br /> Cooler Receipt Form N' <br /> 1 - <br /> Client: Project:CoolerReceive �.- <-�iir <br /> Cool <br /> er pp��--.c W By: r <br /> Signed: <br />' Was cooler scanned for nese radioactivity,presence of radioactivity,and noted if found? Yes 1CO <br />' Were custody seals present on outside of cooler? <br /> a: If Yes, were they intact? Yes/c_ <br />' b: Were signature and date correct? Yes/No <br /> Yes I No <br /> _ Were custody papers completely filled out? <br /> Ye /No <br /> Did you sign and date the custody papers in the appropriate place? es o <br /> Was a shippers packing slip attached to the cooler? <br /> Yes <br /> What kind of <br /> packing material was used' r� <br /> F Was sufficient ice used? No Temperature. i. 3bc- Date; - <br /> I <br /> Were all bottles sealed in plastic bags? <br /> eslNo <br /> Did all bottles arrive intact? <br /> (Yis <br /> 1 No <br /> Were all bottles labeled correctly? (ID,Analysis,Dates, Times) Yes 1 No <br /> Were_the correct containers included for the tests required? <br /> Ces/No. <br /> r. 4w f� T � • S' <br /> Were all VOA vials checked for headspace? <br /> NA 1 es Na <br /> Was sufficient volume of sample sent in all-contain ? <br /> p �• No <br />' Were correct preservatives-used? Q�f <br /> No <br /> _ A proved by:• <br /> Date: aZ <br /> T - no# approved: N e of p son contacted <br /> Date:��r <br />