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STL San Francisco <br /> Sample Receipt Checklist <br /> iSubmission #•2005- 0 —096 } <br /> >7Ar�° L7 <br /> C e- lit Piet ya <br /> i <br /> Conner s SF <br /> urier ( ; Fedex UPS Other Client <br /> /// Yep �o Comments <br /> LQ664n - <br /> I Custody seats intact on shipping containerlsamples <br /> f Chain of custody present? <br /> / I— picked Up a1 secure Location <br /> 3 Chain of custody signed when relinquished and received? Client signed-off at time prior to pickup <br /> 4 All samples checked when COC relinquished <br /> 5 Chain of custody agrees with sample labels? <br /> 6 Samples in proper containerlbottle? <br /> 7 Sample containers intact? <br /> a Sufficient sample volume for indicated test? <br /> g All samples received within holding time? <br /> Cooler Temperature Compliance Check <br /> CooferSample TemR�rure'm - <br /> Teinperature'Blank Reading ' if—trip blank Is submitted #l #2 - #3 iverage- <br /> Individual temperatures musl <br /> be taken as per SDP <br /> rptex Saixip10S_ ith Semp,>&IG-Comments <br /> Reason forl"levated Tempe_ <br /> r -Ice Melted r Insufficient Ice r <br /> r 5amp in boxes r sampled <4hr r ice not req <br /> VSA Sample lnsPeCttori - <br /> 4 - <br /> - -Small Mad Lar e Samples with broken, <br /> - z y Sample# p O ® ti cracked or leaking containers <br /> ArsNbubblea presentin any <br /> the VOA` r r <br /> - vials?1 �- <br /> 4 { _ <br /> rnpls vtirith unacceptable pH <br /> s� Yes - No <br /> Water-pH acceptable-upon receipt? r <br /> ❑ pH adjusted— Preservative used ❑ 1-NO,❑ HCI ❑ HzSO, <br /> E] NaOH ❑ ZnOAc—I_ot#(s) <br /> Comments <br /> Project Management [Routing for instruction of indicated discrepancy(ies}] <br /> Date ! 105 Client contacted <br /> Yer Nr- <br /> Project Manager (mitials) <br /> I <br /> Summary of discussion <br /> i <br /> Corrective Action (per PM/Client) 7005 CheCklcl Ven 20 <br />