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Mom STL <br /> STL Satn Francisco <br /> Sample ,Receipt Checklist <br /> laubmisslon # 2004- <br /> Checklist completed by (initials) Date y /ISO 104 <br /> Courier name `STI_San Francisco ❑ Client <br /> Not <br /> Custody seals intact on shipping container/samples Yes No Present <br /> Chain of custody present? Yes r No <br /> Chain 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 / No <br /> Sample containers intact? Yes No <br /> Sufficient sample volume for indicated test? Yes No <br /> All samples received within holding time? Yes No <br /> C t 'er F3 k to till e�i � ,� �1sr <br /> ''' "° m ' ,�'e <br /> - Ah <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-0), M (medium- 0)or L(large-- 0) <br /> Water- pH acceptable upon receipt? ❑Yes 0 No <br /> ❑ pH adjusted-'Preservative used ❑ HNO3 0 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 discrepancy(ies)] <br /> Project Manager (initials) Date 1 104 Client contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> *orrecttve Action (per PM/Client) <br />