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TestjlmeriE <br /> Nashville Division <br /> COOLER RECEIPT FORM BC# <br /> _ 380653 <br /> Chent Name Eft <br /> ICooler Received/Opened On: 6130104 Ac scion d y: Mark Beasley <br /> Log-in Person Signature <br /> 1. Temperature of Cooler when tnaged: `1' Degrees Celsius <br /> I 2 Were custody seals on outside of cooler' YESNO. NA <br /> I <br /> a- <br /> ikind f yes,how many,what and where <br /> 3 Were custody seals on containers and intact? YES NA <br /> I4. Were the seals intact,signed,and dated correctly9 YES NO NA <br /> 5 Were custody papers inside cooler' . . ... . . . 'S NO NA <br /> I6 Were custody papers properly filled out(mk,signed,etc)? . E - NO NA <br /> 7 Did you sign the custody papers in the appro riate place? NO NA <br /> 8 What kind of paclang material used Bubblewrap Peanuts Vermiculite Other None <br /> 9 Cooling process (Gc - Ice-pack Ice(direct contact) Dry ice Other None <br /> 10 Did all containers arrive in good condition(unbroken)" t� NO NA <br /> 11 Were all container labels complete(#,date,signed,pres,etc)9 . NO NA <br /> 12 Did all container labels and tags agree with custody papers? NO NA <br /> 13 Were correct containers used for the analysis requested //ESS� NO NA <br /> 14 a. Were VOA vials received9 . . .. .. . .. . &—\ NO NA <br /> b Was there any observable head space present in any VOA vial9 Q YES NA <br /> I15 Was sufficient amount of sample sent in each container9 G> NO NA <br /> 16 Were correct preservatives used?. . . 10 NO NA <br /> IIf not,record standard ID of preservative used here <br /> 17 Was residual chlorine present9 .... NO S NA <br /> I8 Indicate the Airbill Tracking Number(last 4 digits for Fedex only)and Name of Courier below <br /> 1 1693 1 � <br /> IUPS Velocity Airborne Route Off-street Fedex Misc <br /> 19 If a Non-Conformance exists,see attached or comments below <br /> I <br /> ICooler Receipt Form LF-1 Revised 313104 <br /> End of Form <br />