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f TESTAMERICA INC.-NASHVILLE COOLER RECEIPT FORM ' Chert _S I Nva l .� � BC#_a2Z l Co"ItAceived On: f G'z- And Opened On: qBy;Ben Wright-/e;zo (Signature) r1 TAmature of Cooler when opened Z,'5—De reel Celsius z' Wtecustody seals on outside of cooler?.,. •• •• •• • •••C .NO ' — �L Ott a. If yes, how many, what kind and where- 1 {147 � ��__ r A- 3, vete custody seals on containers and intact?.......................................... NO ..YES 4' Were the seals intact,signed, and dated correctly?..... .. .....................fid.. . . . ... . . Al�- T S. Were custody papers inside cooler? ... ... ....... . . .. . . ... YEs ..NO ....... 6. Were custody papers properly filled out (ink,signed,etc)? .. . _. ....... .NO 7. Dtdyoa sign the custody papers in the appropriate place? ........ ....NO 8' Whit Idnd of packing material used? ub lewra Peanuts Vermiculite Other None 9' Was sufficient ice used (if appropriate)? .. .. .. .......�..NO 10. Did aD bottles arrive in good condition(unbroken)? ............ ..... ..... ......... YE ..NO 11. Were all bottle Iabels complete (#,date,signed,pres,etc)?.. ....... ... . ......,.. NO 12 Did all bottle labels and tags agree with custody papers?.. ..... .. .. . ...�6. -NO ' 13 were correct bottles used for the analysis requested? ... .. . . FS .NO Y a• Were VOA vials received?.............................................................(68...N0 ' b, Was there any observable head space present in any VOA vial?............. .Np...YES ' 15 Was Sufficient amount of sample sent in each bottle? NO 16 Were correct preservatives used? . .. ... ,..... ....., ...NO 17, Was residual chlorine present?............................................. ..............�8 18. Corrective action taken, if necessary: _ See attached for resolution Cooler A.,. _�ri_-- T „ . aiv)ina - _ __--