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f <br /> 1 <br /> Sample Receipt Checklist STL San Francisco <br /> ' Submission #: 2002- n 5 - D 51 s <br /> ' Checklist completed by: (initials) late: J 1102 <br /> Courier name: �j STL San Francisco ❑ Client Not / <br /> ' Custody seals intact on shipping container/samples Yes No Present ✓ <br /> Chain of custody present? Yes,�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 /> 1 Container/Temp Blank temperature in compliance (40 C±2)? Temp: 1 5 C Yes ✓ No <br /> Water-VOA vials have zero headspace? No VOA vials submitted Yes No <br /> (if bubble is present,refer to approAmate bubble size and itemize in comments as S(small-O), M (medium- O)or L(large- a) <br /> ' Water-pH acceptable upon receipt? ❑ Yes ❑ No <br /> ❑ pH adjusted- Preservative used: ❑ HNO3❑ HCI ❑ H2SO4 Q NaOH ❑ZnOAc <br /> ' For any Rern check-listed "Ho",provided detail:of discrepancy in comment section below: <br /> Comments: <br /> 1 <br /> Project Management [Routing for instruction of indicated discrepancy(ies)] <br /> Project Manager: (initials) Date: / 102 <br /> Client contacted: ❑ Yes ❑ No <br /> Summary of discussion: <br /> rrective Action (per PM/Client): <br />