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moman <br /> STL <br /> STI ,San,Franctsco <br /> Sample Receipt Checklist <br /> Submission # 2003- /0 - aT7 <br /> ei7'~ <br /> Checklist completed by (initials) &W Date ib 1 C)T /03 <br /> Courier name ❑ STL San Francisco k Bent <br /> Not / <br /> Custody seals intact on shipping contacnerlsamples Yes No Present ' <br /> Chain of custody present? Yes__LZ`No <br /> Chain of custody signed when relinquished and received? Yesl,LNo <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 /> Container/Temp Blank temperature in compliance (40 C f 2)? Temp tC Yes L---No <br /> Ice Present Yes_�IQo <br /> Water-VOA vials have zero headspace? No VOA vials submitted Yes I/ No <br /> �(if bubble is present, refer to approximate bubble size and itemize in comments as S (small--O) M (medium — 0) or L (large — O) <br /> Water- pH acceptable upon receipt? )(Yes ❑ No <br /> ❑ pH adjusted— Preservative used ❑ HNO3 ❑ NCI ❑ H2SO4 ❑ NaOH ❑ ZnOAc—Lot#(s) <br /> For any item check-listed "No", provided detail of discrepancy in comment section below <br /> Comments LA 4A cs C� cSw ) �I Y-) <br /> Project Management [Routing for instruction of Indicated dlscrepancy(les)] <br /> Project Manager (initials) Date 1 103 <br /> Client contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> Corrective Action (per PM/Client) <br />