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SFL <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> 106himission #:2004- <br /> CheGklrst ccmDlered by (rnrtral5) Date i Yoe <br /> Courrei name 11 5 f I. ;pan Francisco 0 Client �� <br /> _,_...r r Not <br /> Gastody seals rr ,art o shr pr�ag ca c �mples ye, talo Present <br /> Cham of custody present? Yes '�No <br /> Chain of custody Gicned when relinpurshed and r+ereived? yes No <br /> Cham of cijstodi sprees with ,amps a labels' Yes ✓ No <br /> Samples.n propr�r romainerlbutllen Yep /� No� <br /> Sample containers intact? Yes,_._f No <br /> Sufficient sample volume for indicated test? Yes No <br /> All samptes received w0hin holding time? Ye S_ ,talo <br /> ContamerrTemp Blank tenoplerature to comptrance (4' C:L 2)7 Temp :.Z°C`. Yes No <br /> Potential reason for>G°C - Ice melted 0 Ice in bags 0 Not enough Ice © Not enough blue ice C Samples In bo"s EJ <br /> Sampled -~4hr.ago7U Ice not require (f g airy talk sample) / <br /> Ice PreWe:/Yes <br /> Yes No ►/` � <br /> Oatier- '10.1 vz .l:, have 7erfi hsadspoa e? Ns VOA vials submitteJ No <br /> (Ir bUbble is present, reser to approxicnale bubble size and itemize in comments as S (small -0) M (medium -- 0) or L (large 0) <br /> Water pH acceptable upon receipt? 0 Yes 0 No <br /> © pH adjusted-- Preservative usf�o © MN03 ❑ ICI ❑ H2SO; Cl NaOH ❑ ZnCAc--Lot#(s) <br /> For any item check-listed "No", prodded detail of discrepancy in comment section below <br /> Comments <br /> Project Management [Routing for Instruction of Indicated dlscrepancy(ies)] <br /> Prclect Manager (initials) Dae J 104 Client contacted Q Yes 0 No <br /> Surninary ca oascussion <br /> larrectrre Actwn (pe,Pm1clrent) <br />