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® STL
<br /> STL San Francisco
<br /> Sample Receipt Checklist
<br /> Oubmission # 2004- � - ate C - _
<br /> Checklist completed by (initials) Date 13 LI04
<br /> Courier name `feSTL San Francisco ❑ Client
<br /> Not
<br /> Custody seals intact on shipping containerlsampies Yes No Present
<br /> Chain of custody present? Yes—Z 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 /> Sample containers intact? Yes _No
<br /> Sufficient sample volume for indicated test? Yes_ 9/ No
<br /> All samples received within holding time? Yes / No
<br /> .,., �..e ,..,�sr`,� ,-^,�,a.«^ ra O ` .""".""° .rr , .�.,,,
<br /> Contair�erlTemp�Blarikbtemperaturen cpmpliance�(;�a C ±2)? a r a , , �R �' n Temp _x<C - Yes ��No u�
<br /> � '�"n
<br /> �
<br /> r..y��]'... w �? b � nib`�� y, F E � • � s's ,+`���r„Eia+s Er' € i`� � �
<br /> Potentral,reas©n for><"6f Qx�ice melted,U�rice°lr,bags ©,NNot`ertoudMce�"❑, Not enau6h blue ice El Samples in bo e`s�© `
<br /> F �, T E� `
<br /> E {3XkEy 'r` �E; k;w � r _ �x( ,E .n� s ` ,ate. 3� 3�? e .gra`
<br /> :r r s€ �' ''a 3 s 3, �,, U-
<br /> 3,
<br /> A
<br /> ,Sampled 4hrI'ago?CJ `�EceinotIrequired (e,g, air,or bulk,sample)='
<br /> "�'c ,4 0 qZ
<br /> r, �r , �, x , < '„ Ice�Present Yes,, s No
<br /> ..�Z"_g�ti`., �..,..v{' .-_. .._ a,k,.�.., 3...._..aF,r _
<br /> Water-VOA vials have zero headspace? No VOA vials submitted Yes No-1—
<br /> (if bubble is present, refer to approximate bubble size and itemize in comments as 5(small --0) M (medium - O) or L(large-- Q)
<br /> ' Water- pH acceptable upon receipt? ❑ Yes ❑ No
<br /> ❑ pH adjusted- Preservative used ❑ HNO3 ❑ HCl❑ H2SO4 ❑ NaOH ❑ZnOAc-Lot#(s)
<br /> For any item check-lasted "No", provided detail of discrepancy in comment section below
<br /> Comments / t-J _o'2 //7-5
<br /> rProject Management [Routing for Instruction of Indicated dlscrepancy(les)]
<br /> Project Manager (initials) Date / 104 Client contacted 0 Yes © No
<br /> ' Summary of discussion
<br /> r�--,orrective Action (per PM/Client)
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