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(n r) CO <br /> ® S T L <br /> STL San Francisco <br /> i Sample Receipt Checklist <br /> Cibmission # 2004- 3 - C 3�6,57_' <br /> Checklist completed b (initial Date 031I04 <br /> Courier name >3STL San Francisco © Client <br /> Not <br /> Custody seals intact on shipping container/samples Yes No Present <br /> Chain of custody present? YesNo <br /> Chain of custody signed when relinquished and received? Yes�o <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__7z___No <br /> All samples received within holding time? Yes-401, <br /> es No <br /> ContainerlTemp Blank temperature in compliance (40 C±2)? Temp�1 .c Yes N o <br /> Ice Present Yes � Ido <br /> Water-VOA vials have zero headspace? No VOA vials submitted Yes No <br /> 9 <br /> (if bubble is present, refer to approximate bubble size and itemize in comments as S (small--O), M (medium - O)or L(large - O) <br /> Water- pH acceptable upon receipt? ,8 Yes ❑ No <br /> ❑ pH adjusted- Preservative used ❑ HNO3 0 HCI © H2SO4❑ NaOH 0 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(tes)1 <br /> Project Manager (initials) Date 1 I04 <br /> Client contacted ❑ Yes 0 No <br /> Summary of discussion _ <br /> —Orective Action(per PM/Client) <br />