Laserfiche WebLink
Testj�meriq <br /> ANALYTICAL TESTING CORPORATION <br />' Nashville Division <br />' <br /> COOLER RECEIPT FORM BC#O <br /> 388871 <br /> Client Name : r <br />' Cooler Received/Opened On: 9/10104 Accessioned By: Shawn Grace <br />' Log-m ffersonnel Signature <br /> 1 Temperature of Cooler when triaged: ° Degrees Celsius <br /> 2 Were custody seals on outside of cooler' . YE NO NA <br /> a. If yes,how many,what kind and whereI I �f—r"�k 1 <br />' , .. YES NA <br /> 3 Were custody seals on containers and intact . . <br />' 4. Were the seals intact,signed,and dated correctly' YES NO NA <br /> 5 Were custody papers inside cooler? YE .NO NA <br />' 6 Were custody papers properly filled out(ink,signed,etc)' YES NO NA <br /> 7 Did you sign the custody papers in the appropriate place' YES NO NA <br />' 8 What kind of packing material used? Bubblewrap Peanuts VermiculiteOther ne <br /> 9 Cooling process ce Ice-pack Ice(direct contact) Dry ice Other None <br />' 10 Did 811 containers arrive in good condition(unbroken)" YES NO .NA <br /> 11 Were all container labels complete(#,date,signed,pres,etc)' NO NA <br />' 12 Did all container labels and tags agree with custody papers' YES NO NA <br /> 13 Were correct containers used for the analysis requested' YES NO NA <br /> 1 (Z <br /> 14 a. Were VOA vials received' S NO NA <br /> b Was there any observable head space present in any VOA vial' 0 S NA <br />' 15 Was sufficient amount of sample sent In each container' YES NO NA <br /> 16 Were correct preservatives used' NO NA <br />' If not,record standard ID of preservative used here <br /> 17 Was residual chlorine present? . - NO YES <br /> liv <br />' 18 Indicate the Airbill Tracking Number(last 4 digits for Fedex only)and Name of Courier below <br /> 7 qC <br /> ied- UPS Velocity Airborne Route Off-street Misc. <br />' 19 If a Non-Conformance exists,see attached or comments below <br />' Cooler Receipt Farm LF-1 Revised 3/3/04 <br /> End of Form <br />