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® STL <br /> STL San Francisco <br /> i Sample Receipt Checklist <br /> Submission #.2004- G _ 6� 75S <br /> v1 <br /> Checklist completed by (initials) Date C 1 2104 <br /> Courier name ,�J STL San Francisco ❑ Client <br /> ` Not <br /> Custody seals intact on shipping containerlsarnplcE; Yes No Present <br /> Chain of custody present? Yes ✓ No <br /> Chain of custody signed when relinquished and received? Yes 41 No <br /> Chain of custody agrees with sample labels? Yes -----No <br /> Samples in proper container/bottle? Yes�o <br /> Sample containers intact? Yes -�No <br /> Sufficient sample volume for indicated test? Yes 1--_`No <br /> All samples received within holding time? G� Yes ,--"No <br /> ContamerlTemp Blank temperature in compliance(40 C t 2)? Temp r°C Yes f/ No <br /> Ice Present Yes ✓ No <br /> ater-VOA vials have zero headspace? No VOA vials submitted Yes�o <br /> (if bubble is present, refer to approximate bubble size and itemize in comments as S (small--O), M (medium— Q) or L (large— 0) <br /> Water- pH acceptable upon receipt? Z Yes ❑ No <br /> ❑ pH adjusted— Preservative used ❑ HNO3❑ HCl ❑ 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 dlscrepancy(ies)] <br /> Project Manager (initials) Date 1 104 <br /> Client contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> orrective Action (per PM/Client) <br />