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mm STL <br /> iSTL San Francisco <br /> Sample Receipt Checklist <br /> Submission #:2004- 5 <br /> Checklist completed by (initials) Date "1 <br /> Courier name CTL San Francisco 0 Client Not <br /> Custody seals intact on shipping container/samples Yes No Present <br /> Yes v No <br /> Cham of custody present? <br /> Chain of custody signed when relinquished and received? Yes No <br /> Chain of custody agrees with sample labels'2 Yes No <br /> YesNo <br /> Samples in proper container/bottle? � <br /> Yes <br /> Sample containers intact? ��0 <br /> Sufficient sample volume for indicated test <br /> Yes v <br /> Yes No <br /> All samples received within holding time? <br /> Containerfremp Blank temperature in compliance(4°C t 2)? Temp��°C Yes o <br /> Ice Present Yeso <br /> Water-VOA vials have zero headspace? No VOA orals submitted Yes No <br /> (if bubble is present, refer to apprommate bubble size and itemlze in comments as S(small-0), M(medium^- <br /> Q)or L(large— Q) <br /> Water-pH acceptable upon receipt? [3Yes O No <br /> 0 pH adjusted— Preservative used ❑ HNO3❑ HCI 0 H2SO4 0 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(ies)] <br /> l Project Manager (initials) —Date / 104 <br /> Client contacted 0 Yes !7 No <br /> l S,immary of discussion _ -- ---.. " <br /> Corrective Action(per PM/Client) <br />