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STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> *ubmission #:2004- - 0060 <br /> ChPC%4$*corrrpleteo by finit:alsi Date 0 1 L}` xg <br /> Cnuner name ❑ ST! San Fri�;scca_.O Chen- .�`� <br /> Ctlstray seals rn,act an sl pPpM ccrimu- rrsarnples Yes No Present <br /> Chain Ot Stcoy presenE7 <br /> Chain or Custody signed when refinquistted and recvved7 Yes I Nlo <br /> Chain of custody agrees vitF sarnpte labels' gyres EVcs <br /> San-,olr3 r) proper :,cntainer,bott;e? "Ps �' No <br /> Sample consailers .nm t? Yes f No <br /> SLIP tCaenj sample LIolumo for Indicated test? Yes �'` tato <br /> All samples received within holding times lies J No <br /> Container Temp Blank temperature in cornpl-ance (4') 2)? Temp 'C Yes ,yQ <br /> Ice Present rVes #Ja� <br /> =,'dater-VCA,,ials have zero headsrnce? No VOA vials submeted / "Yes No <br /> 0 1 <br /> 'if bubble is oreaent, refer to aL)proxrmate bubble wze and itemize in comments as 5 {small r-0) M (medium - 0) or L(cargo - 0) <br /> V ak—r- pH acceptable upon receipts ❑ Yes 0 N t <br /> ❑ pH adjusted- 1:1re5ervative used ❑ HNIO) ❑ HCI ❑ HZSCa 0 NaOH C ZnOAc-Lot ol(s) <br /> For any item check-listed "No", provided detail of discrepancy in comment section below <br /> Comments <br /> Project Management [Routing for instruction of Indicated dlscrepancy(ies)] <br /> Project N'tanager �,nitials) Date 1 104 <br /> Ctterrt cionmctp-d ❑ Yes ❑ No <br /> Summary of discussion <br /> *,re,ti.io Ac, ion (per PKWClieni) <br />