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STL Sart Francisco <br /> Sample Receipt Checklist <br /> Submission # 2005- � f2� <br /> SChecklist completed by DATE <br /> Courier r STL SF Courter r i Fedex UPS Other Client � <br /> ` Log-In Details Yes No Comments <br /> i Custody seals intact on shipping containerlsamples <br /> 2 Chain of custody present? <br /> i Pr ee Up at Secure LOCatwn <br /> 3 Chain of custody signed when relinquished and received? <br /> / l—1 Cheni sgned offal Gee error to o�uo <br /> 4 iAll samples checked when COC relinquished f <br /> 5 Chain of custody agrees with sample labels? 0 <br /> 6 Samples in proper containerlbottle? <br /> 7 Sample containers Intact? <br /> 8 Sufficient sample volume for indicated test? <br /> 9 All samples received within holding time> <br /> Cooler Temperature Compliance Chectc <br /> Temperatura Blank Reading Cooler Sam pie Temperature <br /> if no inp blank is wbrrrtled 91 #2 #3 Average <br /> mdrviduat temperaWres mutt <br /> rie ta6en as per SOP <br /> • Reason for Elevated Temperature Samples with Temp>6°C-Comments <br /> -ice Melted r" lnsufficenl ice r <br /> l— Samp m boxes (� Sampled<4h Ice nol req <br /> VOA Sample Inspection <br /> Small Med Large <br /> Samples with broken, <br /> Sample# 0 0 0 cracked or leaking containers <br /> Are bubbles present in any of the VOA <br /> vials? <br /> F I E <br /> i F <br /> Yes Na Samples with Unaccepfable pH <br /> Water-pH acceptable upon receipt? r I <br /> G pH adjusted— Preservative used ❑ HNO,© HCl C h7SO,0 NaOH ❑ ZnOAC–Lot#(s) <br /> Comments <br /> Project Management [Routing for instruction of indicated discrepancy(les)l <br /> Project Manager (initials) —Date 1 105 Client contacted YJ N <br /> Summary of discussion <br /> Corrective Action (per PM/Client) <br /> 2005 Ci•e[kUst Vsr 2 0 <br />