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A <br /> STL <br /> STL San Francisco <br /> is= ) Sample Receipt Checklist <br /> Su mission #-2004- � S- <br /> Choc klist opmpWtecl by; (initials)� Date- 0-5-II04 <br /> Gou er name; 0 STI_ Sen Francispo In Tient A B C, ��t, <br /> Not <br /> Cust ;dy'se*Intact on 9Mpplog Onteinerlsamplds Yea No Present-- <br /> Chai 1 of custody present? <br /> Chai 1&custody MOW when reiin.quished and received? Yes No <br /> Chai i of custody agrees Wth sample labels? Yes No <br /> Sam les In proper conti ri edbpttle? Yes ✓No <br /> Sam ale containers intact? Yes Ila <br /> Suf$ lent sample volume for 1041cated test? Yes ` No <br /> All'si mfts rec eived.withio holding tirne? Yes ' ' No <br /> Con �herfTemp Blank temperature in compliance(4°b±2)? Temp:,� °C YPS NG <br /> Ice Present Yas V Nci <br /> Walr-VOA vlots have.zero headsp8ce,? No:VOAvials submitted Yes, <br /> (it b bble is:.present,ref6r-t6-appri drn Me,LOWo.a"and itemize lin cnitjitlents s S (small-thy..tN(rrir~diun� y or l (large-t!) <br /> Water-pH accepta.ble,u.pon.receipt? 4 Yes ❑X18 <br /> El pi i adjusted- Preservative-used; ❑HNOs:111.40 0 H2$0 .0 NADH 0 znOAo-Lot Old), <br /> For iny AB:Fn Gh$cic;:1am.61 'talo", pravlded detail 6fd9 4repiap:cy tri;0.mrrlW*sbdggn bdtb -. <br /> C6T entp, <br /> I Pr d6_ct-Ma�Age'M': 11t IRoUtirrg fair in-stlruction of Wicatkd disotepanaY(i+ws�] <br /> 1 Pro 06i Marlag'er.' (lutists) nate; [3�F <br /> k 1 CCl[1t fed: ;Q Yids O 'N <br /> sau rrtary esf stfatsiort <br /> i <br /> C.o` aw1W Action(per PAAICIian <br /> Ef - <br /> 4 <br /> r <br />