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COOLER RECEIPT FORM <br /> ect: <br /> t5 or-21 - Lag No: <br /> 9ler receive on. -jand checked an - y <br /> signa e <br /> Were custody papers present) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3E-ESr NO <br /> Were custody papers properly filled out? . . . . . . . . . . . . . . . . . y—' NO <br /> Were the custody papers signed . . . . . . . . . . . . . . . . . . . . . . . . . ..Y'Es NO <br /> Was sufficient ice used? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YLP'S NO —TlQ.`. Db( <br /> Did all bottles arrive in good condition (unbroken) ) . . . . . . . NO <br /> Dial bottle labels match COC"> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Y-LS NO <br /> Were proper bottles used for analysis indicated? . . . . . . . . . . Y-PS NO <br /> Correct preservatives used' . . . . . . . . . . . . . . . . . . . . . . . . . . . ..Y-PS NO <br /> VOA vials checked for headspace bubbles? . . . . . . . . . . . . . . . . . . Y-ES NO <br /> Note which voas ( if any) had bubbles: * <br /> Sample descriptor. Number of vials : <br /> 4 <br /> *All VOAs with headspace bubbles have been set aside so they will not Le <br /> used for analysis. . . . . . . . . YES NO <br /> List here all other fobs received in the same cooler: <br /> Client Job # NET log # <br />. (coolerrec) <br />