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STL <br /> TL San Francisco <br /> Sample Receipt Checklist <br /> mission #.2004- <br /> 1 <br /> Checklist completed by (initials) Datey� / 104 <br /> Courier name ❑ STL San Francisco ❑ Client A Be C- <br /> Not f <br /> Custody seals intact on shipping container/samples Yes No Present <br /> llhain of custody present? Yes ✓ No <br /> Chain of custody signed when relinquished and received? Yes No <br /> Chain of custody agrees with sample labels? Yes No <br /> Samples in proper container/bottle? Yes No <br /> ample containers intact? Yes No <br /> Sufficient sample volume for indicated test? Yes --�'No <br /> F11 samples received within holding time? Yes No <br /> Container/Temp Blank temperature in compliance (40 C t 2)? Temp °C Yes No <br /> 1 Ice Present Yes No <br /> Water-VOA vials have zero headspace? No VOA vials submitted Yes ✓ No <br /> ftp� <br /> (if bubble is present, refer to approximate bubble size and itemize in comments as S (small-0), M (medium- Q) or L(large - O) <br /> Tater-pH acceptable upon receipt? ❑ Yes ❑ No <br /> fpH adjusted- Preservative used ❑ HNO3 ❑ HCI ❑ H2SO4 ❑ NaOH D ZnOAc-Lot#(s) <br /> or any item check-listed "No", provided detail of discrepancy in comment section below <br /> omments <br /> Project Management [Routing for Instruction of indicated discrepancy(ies)] <br /> troject Manager (initials) Date 1 104 <br /> Client contacted ❑ Yes ❑ No <br />,Summary of discussion <br /> ctive Action (per PM/Client) <br /> 1 <br />