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STL <br /> STL San Francisco <br /> 0 Sample Receipt Checklist <br /> Submission #:2004- - 69 <br /> fy <br /> Checklist completed by (initials) Date "I P,5� /44 <br /> Courier name ITL San Francisco ❑ Client <br /> Not <br /> Custody seals intact on shipping containerfsamples Yes No Present <br /> es <br /> Chain of custody present? Yes P No <br /> Cham 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 <br /> No <br /> Sample containers intact? Yes No <br /> Sufficient sample volume for indicated test? Yes c <br /> All samples received within holding time? Yes No <br /> Container/Temp Blank temperature in compliance(40 C±2)? Temp_4Z__°C Yes 1,1 o <br /> Ice Present Yes o <br /> �ater-VOA vials have zero headspace? 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-- O) or L(large— V) <br /> Water-pH acceptable upon receipt? ❑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(ies)] <br /> Project Manager (initials) Date 1 I04 <br /> Client contacted ❑ Yes ❑ No <br /> Stimmary of discussion <br /> Corrective Action (per PM/Client) <br />