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® STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> bibmission # 2004- 69 % - �1!�5 1 7 <br /> iChecklist completed by (initia �-_ Date Y / iO4 <br />' Courier name ❑ STL San Francisco ❑ Client �-- <br /> Not <br /> Custody seals intact on shipping container/samples Yes No Present <br /> Chain 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 to proper container/bottle? Yes__ZNo <br /> Sample containers intact? Yes,--' No <br /> Sufficient sample volume for indicated test? Yes-Z—_No <br /> All samples received within holding time? u Yes No <br /> Container/Tem Blank temperature in compliance 4° C ±2)? Temp -I,l °C Yes No <br /> p p P ( <br /> Ice Present Yes 4-No <br /> Water-VOA vials have zero headspace? No VOA vials submitted Yes No <br /> PD <br /> (if bubble is present, refer to approximate bubble size and itemize in comments as S (small --O), M (medium - O) or L (large - Q) <br /> Water- pH acceptable upon receipt? I*Yes ❑ No <br /> ❑ pH adjusted- Preservative used ❑ HNO3 ❑ HCI ❑ 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 discrepancy(les)] <br />' Project Manager (initials) Date 1 104 <br /> Client contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> OrectiveAction (per PM/Client) <br />