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' Sample Receipt Checklist STL San Francisco <br /> Submission # 2002- - <br />' Checklist completed by (Lnitials)ae DateI�J ,u2 <br /> ' Courier name ❑ STL San Francisco El !Client A't.C_(R ._ /Not ✓ <br /> Custody seals intact on stripping container/samples Yes No Present <br /> ' Chain of custody present? Yes No <br /> Cham of custody signed when relinquished and received? Yes ✓ No <br /> Chain of custody agrees with sample labels? Yes ,/- No <br /> ' Samples in proper contamedbottle? Yes / No <br /> Sample containers intact? Yes `� No <br /> ' Sufficient sample volume for indicated test? Yes No <br /> All samples received within holding time? Yes No <br /> Containerfremp Blank temperature in compliance (40 C+2)? Temp `z °C Yes No <br /> ater-VOA vials have zero headspace? No VOA vials submitted Yes No <br /> (if bubble is present, refer to approximate bubble size and itemize in comments as S (small -O), M (medium -- 0)or L(large— V) <br /> Water-pH acceptable upon receipt? ❑Yes ❑ No <br /> ' 0 pH adjusted— Preservative used Cl HNO3❑ NCI ❑ H2SO4 ❑ NaOH ❑ ZnOAc <br /> For any item check-listed "No", provided detail of discrepancy in comment section below <br /> ' comments- <br /> Project Management [Routing for instruction of Indicated dlscrepancy(Ies)] <br /> ' Project Manager (initials) Date 102 <br /> Client contacted ❑ Yes ❑ No <br /> ' Summary of discussion <br /> Corrective Action (per PMIClient) <br />