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' STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> *Submission #:2004- �I� - V5 <br /> ( <br /> r�� <br /> Checklist completed b initials I 104 <br /> P Y ( } Date: <br /> ' Courier name: ❑ STL San Francisco ❑ Client <br /> Not <br /> Custody seals intact on shipping container/samples Yes No Present 6/ <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? Yesy No <br /> All samples received within holding time? Yes Y No <br /> ' ? [� ° ✓ <br /> ConEainerlTemp Blank temperature in compliance (40 C±2). Temp. C Yes No <br /> ' Ice Present YesNo/ <br /> Water-VOA vials have zero headspace? No VOA vials submitted Yes �✓ No <br /> (if bubble is present, refer to approximate bubble size and itemize in comments as 5(small—O), M (medium— O) or L(large- O) <br /> ' Water-pH acceptable upon receipt? ❑ Yes E7 No <br /> ❑ pH adjusted— Preservative used: ❑ HNO3 ❑ MCI © H2SO4❑ NaOH ❑ZnOAc—Lot#(s) <br /> For any item check-listed "No", provided detail of discrepancy in comment section below: <br /> Comments: _Z1 <br /> `T Cj L P 'F D F-o F'L -C <br /> ' Project Management [Routing for instruction of indicated discrepancy(ies)] <br /> ' Project Manager: (initials) Date: 1 104 <br /> Client contacted: ❑ Yes ❑ No <br /> ' Summary of discussion: <br /> 1 <br /> C� Corrective Action(per PM/Client): <br /> 1 <br />