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' r <br /> Cooler Receipt Form <br /> � •1 <br /> Client. dt Project• <br /> Date Cooler Re eived z I-.t o Date Cooler Opened _ WX a <br /> Was cooler scanned for presence of radioactivity No <br /> a• Was radioactivity results above 25cpm9 es No <br /> If cooler had custody seal(s), were they signed and intact NA Yes /No <br /> Was a shipper's packing slip attached to the cooler? Ye /No <br /> Cooler was packed with Ice � Ice Packs Bubble Wrap Styrofoam <br /> Paper None Other <br /> Temperature of cooler- 6. i <br /> *Cooler needs to be received @ 4°C with an acceptable range of 2°-6°C <br /> Were all samples sealed m lastic bags Yes No <br /> Did all samples arrive intact? If no, see below Yes No <br /> Were all samples labeled correctly? (ID, Dates, Tunes) If no, see below Yes No <br /> Can the tests required be run with provided containers? If no, see below Q <br /> Y s No <br /> Was sufficient volume of sample sent in all containers? fNAYes <br /> No <br /> Were any VOA vials received with headspace'� /No <br /> Werecorrect preservatives used? /No <br /> *If no, see pH Log for a list of samples and container pH <br /> Any other unportant miformat' <br /> _ Signed• Date: z! <br />