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STL <br /> STL San Francisco <br /> • Sample Receipt Checklist <br /> Submission # 2004- - (5 EZ 33 <br /> Checklist completed by (initials) � Date 1104 <br /> Courier name �1 STL San Francisco ❑ Client <br /> / �. Not � <br /> Custody seals intact on shipping container/samples Yes No Present <br /> Chain of custody presents Yes No <br /> Chain of custody signed when relinquished and received? Yes No <br /> Chain of custody agrees with sample labels? Yes_ZNo <br /> Samples in proper containerlbottle? Yes No <br /> Sample containers intact Yes-_Z/No <br /> Sufficient sample volume for indicated test? Yes_�ZNo <br /> All samples received within holding time? Yes P-/No <br /> Contamerfremp Blank temperature in compliance(40 C-12)1 Temp 02` 1 °C Yes ✓ No <br /> Ice Present Yes ✓ No <br /> ter-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 --0, M (medium - 0) or L (large- 0) <br /> Water- pH acceptable upon receipt7 lk es ❑ No <br /> ❑ pH adjusted- Preservative used ❑ HNO3 0 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 / 104 <br /> Client contacted ❑ Yes 0 No <br /> Summary of discussion <br /> orrective Action (per PM/Client) <br />