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STL LOS ANGELES - PROJECT RECEIPT CIUCKLIST Date: -� <br /> Single Cooler only <br /> IMS Lot#, rcAPLA6 2-1() Quote# <br /> lent Name TI _ Project 14r-- <br /> Received by Date/Tune Received L_y Vit?fry b <br /> Delivered by ❑ Client ❑ STL ❑ DHL(fAed Ex ❑UPS ❑ Other <br /> «t»tsatt*«*»»»*st»»tt+a«»««»t»»t»t»» atattst*s*tt*sk»»»*s***+++**t�v»**»tss***:s«+*r«#tta«»t»t*tt++tt+tt*tsa*+aa»»a Initkal Date <br /> Custody Seal Status Cooler C26tact ❑Broken ❑None <br /> Custody Seal Status Samples ❑Intact ❑BrokenC�None <br /> Custody Seal#(s) �o -7 ❑No Seal# <br /> Sampler Signature on COC ❑ Yes ❑No < &WA <br /> IR Gun#,A Correction Factor -8—°C ed daily verification s ❑No <br /> Temperature-BLANC Q. 0C - $�CF Cooler#1 IED <br /> Temperature—COOLER( °C °C °C °C) = avg°C -�8_CF = °C _ <br /> Samples outside temperature criteria but received within 6 hours of final sampl�.ng El Yes �UA <br /> Sample Container(s) ❑ STL-LA Client ; t <br /> pH measured ❑ Yes ❑Anomaly (if checked,notify lab and file NCM) ),NIA <br /> nomalies ❑No ( Yes gnp�letee CUR and Create NCM <br /> Complete shipment received to good condition with correct temperatures,containers, labels,volumes <br /> preservatives and within method specified holding times ❑Yes 111NO <br /> Labeled by _ S <br /> Turn Around Time ❑RUSH-241IR ❑RUSH-48HR ❑RUSH-72HR 4NORIVIAL '(mac <br /> LEAVE NO BLANK SPACES, USE N/A...""'"" <br /> Headspace Anomaly ❑YES N/A <br /> Lab Ill Container(s)# Headspace Lab W Container(s)# Heads ace <br /> >6mm ❑ >6mm <br /> ❑ >6mm. >6mm <br /> >6mm. n >6mm <br /> ❑ >6mm El >6mm <br /> ❑ >6mm 0 >6mm <br /> ❑ >6mm Q >6mm <br /> ❑ >6mm ❑ >6mm <br /> 040210 4 <br />