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• r <br /> COOLER RECEIPT FORM <br /> pro-iect• 6051(p-S( Log No: <br />::ooler receive on: s an checked on by <br /> (signature) <br />+dere custody papers present? . . . . . . . . . . . . . . 1 . . . 11 . 1 . . . . YE NO <br /> dere custody papers properly filled out? . . . . . . . . . . . . . . . . . .(:YFDs NO <br /> dere the custody papers signed' . . . . . . . . . . . . . . . . . . . . . . . . . NO <br /> 4as sufficient ice used> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YE NO -MkA-4. - d <br /> Did all bottles arrive in good condition (unbroken) ? . . . . . . NO <br /> Did bottle labels match COC? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4�Q NO <br /> Were proper bottles used for analysis indicated? . . . . . . . . . . 4jji� NO <br /> Correct preservatives used" . . . . . . . . . . . . . . . . . . . . . <0 NO <br /> VOA vials checked for headspace bubbles? . . . . . . . . . . . . YE NO <br /> Note which voas ( if any) had bubbles: * <br /> Sample descriptor- Number of vials. <br /> MW <br />*All VOAs with headspace bubbles have been set aside so they will not be <br /> used for analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO <br /> List here all other fobs received in the same cooler: <br /> Client Job # NET log # <br />• <br /> (coolerrec) <br />