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STL San Francisco ' <br /> Sample Receipt Checklist <br /> Submission #.2005- <br /> Checompleted <br /> ` ; com feted b <br /> cldis# p y -y ELATE <br /> Courier (^ STL SF Courier F1 Fedex UPS Other Client -- - - -' <br /> Log-In Detalis Yes No Comments <br /> 1 Custody seals intact on shipping containerlsamples <br /> 2 Chain of custody present <br /> Picked Up at Secure Loeateon ' <br /> 3 Chain of custody signed when relinquished and received? <br /> � rI Chem signed-ott at time prior to pick up <br /> 4 1A11 samples checked when COC relinquished <br /> 5 Chain of custody agrees with sample labels? <br /> 6 Samples in proper containerlbottle'? <br /> 7 Sample containers intact? ' <br /> r , <br /> 8 Sufficient sample volume for indicated test? <br /> 9 All samples received within holding time? ell ' <br /> a Cooler Temperature Compliance Check <br /> Temperature Blank Reading Cooler Sample Temperature <br /> III no[rip blank is submitted #t #2 #3 Ave e <br /> indrvltlual temperatures must � <br /> i A F <br /> n be taken as per SOP �r Z- <br /> Reason for Elevated Temperature - Samples with Temp>&°C-Comments <br /> r` Ice Melted Insufficient Ice r <br /> r <br /> Samp in boxes r Sampled<4hr Ice not req ' <br /> VOA Sample Inspection <br /> Small Med- Large <br /> ' Samples with broken, , <br /> Sample# 0 O 0 cracked or leaking containers <br /> Are bubbles,present in any of the VOA <br /> vials r r <br /> r r � <br /> r � � <br /> Yes No Samples with Unacceptable pH ' <br /> Water-pH acceptable upon receipt's r i <br /> ❑ pH adjusted- Preservative used ❑ HNO3 ❑ HCl ❑ H,SO4 ❑ NaOH O ZnOAc-Lot#(s) _- <br /> _ Comments ' <br /> , <br /> 1 <br /> Protect Management [Routing for instruction of indicated discrepancy(tes)] ' <br /> Protect Manager (initials) Date 1 !05 Client contacted Yer NF_ <br /> Summary of discussion <br /> Corrective Action (per PM/Client) <br /> 2005 ehecklis,ver 2 0 <br />