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imm STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> Submission # 2005- - ��— _ <br /> ' Checklist completed by (initials) CYJ pafe <br /> ' Courier name V<TL San Francisco ❑ Client <br /> Custody seals intact on shipping container/samples Not <br /> Yes No Present E✓� <br /> Chain of custody present? <br /> Yes_�'No <br /> Cham of custody signed when relinquished and received <br /> Yes Flo <br /> ' Chain of custody agrees with sample labels' <br /> Yes No <br /> Sampies in proper container/bottle <br /> Yes Na <br /> Sample containers intact <br /> Yes r No <br /> Sufficient sample volume for indicated test? <br /> Yes e_�'No <br /> I <br /> All samples received within holding time <br /> Yes No <br /> Container/Temp Blank temperature in compliance (40 C± 2)? Temp � °C Yes�No <br /> Potential reason for? 6°C - Ice melted ❑ Ice in bags ❑ Not enough ice ❑ Not enough blue ice ❑ Samples in boxes ❑ <br /> Sampled<4hr ago?❑ ice not required(e g air or bulk sample) ❑ <br /> Water - VOA vials have zero headspace? Ice Present Yes_<No <br /> 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 - Q) or L (large - Q) <br /> Water- pH acceptable upon receipt', ❑ Yes ❑ No <br /> ❑ pH adjusted- Preservative used ❑ HNO3 ❑ NCI ❑ H2SO4 ❑ NaOH ❑ ZnOAc-Lot#(s) <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(les)] <br /> Project Manager (initials} Date / 105 <br /> Ghent contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> 1 Corrective Actoner PM <br /> (p /Client) <br />