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® STL <br /> STL San Francisco <br /> J Z Sample Receipt Checklist <br /> Submission #.2003- [ - n0 Y-D <br /> Checklist completed by (initials) Date / 7- 1 y Z_/03 <br /> Courier name' f STL San Francisco ❑Client <br /> � Not <br /> Custody seals intact on shipping container/samples Yes No Present i <br /> Chain of custody present? Yes �0 <br /> signed Chain of custodyned when relinquished and received? Yes No <br /> 9 Q <br /> Chain of custody agrees with sample labels? Yes-)Le, N0 <br /> Samples in proper container/bottle? Yes_4.e:n No <br /> Sample containers intact? YeA- No <br /> Sufficient sample volume for indicated test'? Yes_L/No _ <br /> All samples received within holding time? Yes E�No <br /> Container/Temp Blank temperature in compliance (41 C t 2)1 Temp .4 C Yes_IZNo <br /> Ice Present Yes_[ Flo <br /> Water-VOA vials have zero headspace? No VOA vials submitted Yes =--.110 <br /> (if bubble is present,refer to approximate bubble size and itemize in comments as 5 (small--0, M(medium-- 0)or L(large- 0) <br /> Water-pH acceptable upon receipt? PrIe-s- © No <br /> ❑pH adjusted- Preservative used ❑ HNO3 0 MCI 0 H2SO4 0 NaOH 0 ZnOAc-Lot#(s) <br /> For any Item check-listed "No", provided detali of discrepancy in comment section below <br /> Comments <br /> Project Management [Routing for Instruction of indicated discrepancy(ies)] <br /> Project Manager (initials) Date 1 103 <br /> Client contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> Corrective Action(per PM/Client) <br />