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-:� Sampie Receipt Checklist STL San Francisco <br /> to Submission #: 2002- - <br /> y Checklist completed by: (initials) 111k Date: .,I IO2 <br /> Courier name: ❑ STL San Fran cisco>�/Client <br /> Not ✓ <br /> Custody seals intact on shipping container/samples Yes No Present <br /> c-; <br /> Chain of custody present? es o <br /> Chain of custody signed when relinquished and received? Yes f No <br /> -� Chain of custody agrees with sample labels? Yes ,/ Na <br /> Samples in proper containerlbottle? Yes fl' No <br /> Sample containers intact? Yes --' No <br /> Sufficient sample volume for indicated test? YesJZNo <br /> All samples received within holding time? c Yes No <br /> Container[Temp Blank temperature in compliance(40 C±2)? Temp: S °C Yes ✓ No <br /> Water-VOA vials have zero headspace? No VOA vials submitted Yes ✓ No <br /> f (if bubble is present, refer to approximate bubble size and itemize in comments as 5 (small-0), M (medium- O)or L(large - 0) <br /> Water-pH acceptable upon receipt? ❑Yes ❑ No <br /> t ❑pH adjusted-- Preservative used: ❑ HNO3❑ HCl ❑ H2SO4 ❑ NaOH ❑ZnOAc <br /> For any item check-listed "No", provided detail of discrepancy in comment section below: <br /> Comments: <br /> t. .j <br /> Project Management [Routing for instruction of indicated discrepancy(ies)] <br /> ' i Project Manager: (initials) Date: 1 102 <br /> Client contacted: ❑ Yes ❑ No <br /> Summary of discussion: <br /> -'1 <br /> Corrective Action (per PM/Client): <br /> r <br />