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® STL <br /> TL San Francisco <br /> Sample Receipt Checklist <br /> Submission #:2004- 0� - <br /> Checklist completed by: (initials) Date: <br /> Courier name: XSTL San Francisco ElClient Not , / <br /> Custody seals intact on shipping container/samples Yes No P--ressH-ni v <br /> Chain of custody present? Yes v o <br /> Cham y g q <br /> 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 LNo <br /> Sufficient sample volume for indicated test? Yes t //,// No <br /> All samples received within holding time? Yes V No <br /> Container/Temp Blank temperature in compliance(40 C±2)? Temp:°C Yes No <br /> Ice Present Yes o <br /> - v zero heads ace? No VOA vials submitted Yes t/ No <br /> ater VOA vials have p <br /> (if bubble is present, refer to approximate bubble size and itemize in comments as S (small-O), M (medium- O)or L(large- V) <br /> Water-pH acceptable upon receipt? ❑ Yes ❑ No <br /> ❑ pH adjusted- Preservative used: ❑ HNO3❑ HCl❑ H2SO4 ❑ NaOH ❑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(ies)] <br /> Project Manager: (initials) Date: 1 104 <br /> Client contacted: ❑ Yes ❑ No <br /> Summary of discussion: Y_ <br /> Corrective Action(per PM/Client): <br /> n <br />