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STL <br /> STL Sari Fran Isco <br /> Sample Receipt Checklist . <br /> Submission :2004- D - 0931 <br /> Checklist complet (initials) _ Date Q 1 104 <br /> Couner name S San Francisco 0 Client <br /> Custody seats int n shipping container/sampleNots Yes Na Present r� <br /> Chain of custody p enP Yes No <br /> Charn of custody ss ed when relinquished and received? Yes--�( fr <br /> Chain of custody ag es with sample labels? Yes No.— <br /> Samples in Proper rttainertbottle? Yes `� No <br /> Sample containers 1 teat-� Yes ✓ No <br /> Sufficient sample v me for indicated test? Yes No <br /> All samples receiv within holding fime7 Yes ✓No <br /> ContarnerFremp 131 k temperature in compliance(49 C 2)> T mp °C Yes Q <br /> Ice Present Yes e- Na i <br /> i <br /> Water-VOA mals h e zero headspace7 No V O vlais ubmitted Yes -"*'No <br /> {lf bubble is present efer to approximate bubble size and itemize in comments as S(sena ,-0).1 A(rnediurn— Q)or L(large— 0) <br /> Water-pH accep ie upon recalpt? © Yes ❑ No <br /> D pH adjusted— P ervalive used D HNO3❑HCl 11 H2SO4❑NaOH 0 ZnOAb--Lit#(a) <br /> I <br /> For any nein cher fisted "No",provided detail of discrepancy fn comment section below <br /> Comments' <br /> Project Mara meet (Routinglor rnstru tion 6f'ind1c4ted',&i6 6pi y(i sy <br /> Project Manager nictals) Date`____/ J04 <br /> Client oantacWd. Yes 0 No <br /> Stm,marY of d-ksott ion , <br /> Corrective Acti©n,'(p PM;Ctient}_ <br />