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S 1'L <br /> STL San Francisco <br /> Olsubmission # 2004- Sample Receipt Checklist <br /> Checklist completed by gn€tials} d I/V\ Bate &B 1 0 3104 <br /> Clciurler nas-ne 11STL San Francisco ❑ Clier.1— i <br /> Cuslody sears In@act ori n, inqcanteln� sainpi s Not <br /> Yes No Prre-`s�enl <br /> �S <br /> Ci)alrl Of Gr ,0'JV present-) Y'e's "" �tO <br /> Charn of custooy signed when relinquished and received? Yes��No <br /> Chan of custoLy,agrees witi) sample la:aefs? Yes No <br /> :Samples In propercpniEa€ricrlt�ottle� <br /> yes Na <br /> Sample containers, tntact? Yes +-- No <br /> S,atf;ctent sampje volrime for indicated tebt? Yes %r' No <br /> � <br /> Atl sarnpies received within holding tune? Yes rte' No <br /> Containerffernp Blank temperature in c impllance (Q"C ±2"? Temp�11`c Yes L--- No <br /> Ice Present Yes No <br /> 0 Walcr- VOA vials have zero headspaceA No VOA vials stibmttterj i,/ Yes No <br /> t if bubbla €s present,refer to approximate babble size and ilernrze In comments as,s (sr11a9f-0) M (medrum -- 0)or L(large— *V) <br /> Vllatct - pH acceptable upon recelpt? ❑ Yes D No (( <br /> .�, <br /> ❑ pH adjusted— Preservative used ❑ HNO; O HC © I1-SO ❑ Na0H © ZnOAc—Lot#(s) <br /> For any item check-listed "No", provided detail of discrepancy in comment sectron below <br /> Comments. � c' � c `. O i- FrPF3.20L <br /> Project Management (Routing for Instruction of Indicated discrepancy(les) <br /> Project Manager (Inrt€als) E]ate 04 <br /> Cl€en contacted Ci Yes ❑ No <br /> Summary of disc ussion <br /> .Corrective Ac#ton 4per PtvlfCGenE} <br />