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tt <br /> 1 <br /> STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> Submission #:2004- ' � <br /> Checklist cOrnpleted by (iniUals) �'�''"t Date c-f - 04 <br /> A <br /> Courier namC © STL Sdn Franc4sco ❑ Client <br /> -^ -- Not <br /> Custody seals mt-art €Tz, �'I ping dont aigar(sarnples Yes Na Present <br /> Cham Of c�stody pr"enO Yes 4f No <br /> (`113111 Of:.uslady airgnecl :Shen telingriishect.end rec- recti Yes Np <br /> Chau;of custrdy agrees tiWrth sample labels? Yes No <br /> ,amplCS III proper conlainvrlt tittle? )es No <br /> Sample Containers intrycl Yes c-1 -No <br /> SufriGient simple volume for indicated test's Yes No <br /> All ';Imples received within holding trme Yes 1' No <br /> t,'ontainerfienip Blank temperature in compliance(4"C 1.2)7 mpY� U tic yes—/ No <br /> Potential reason for> TC-ice m¢Ited❑ Ice in bags 0 Not enough ice Q Mol enough blue'ica Cl Samples in boxes C] <br /> Sampled <Or ago?Q Ice not required Ce!g air r hulk sarnple�)—�` Ice Present Yes N <br /> %�-Jatcr-NICIA,rials have zero neadspar-O No VOA vials subnvied e )Iees No <br /> (if bubol4 is present refer to'approximate bubble size and itemize in cornme:its as S (small-0), 1VI (medium- 0) or L (large -- 0) <br /> Water pH acceptable upon receipt,7 ❑ Yes ❑ No <br /> Q pH adjusted- Preservative used 0 HNCs ❑HCI ❑ HtSC)a© NaOH 0 ZnOA� -Lot#(sl <br /> For any ►tem check-listed "No", provided detail of discrepancy in comment section below! <br /> Comments <br /> Project Management [flouting for instruction of indicated discrepanIcy(les)] <br /> ProjeCt Manager (initials) Date �F 104 Client contacted; ❑ Yes 11 No <br /> Stimmari of discussion <br /> Correctiur:Action (per PttiUChent) <br />