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16 <br /> 1 Sample Receipt Checklist STL San Francisco <br /> Submission #: 2002- D112,2- <br /> Checklist completed by: (initials) Date: <br /> Courier name:,XSTL San Francisco ❑ Client Not <br /> Custody seals intact on shipping container/samples Yes No Present <br /> Chain of custody present? Yes 1// No_ <br /> Chain of custody signed when relinquished and received? Yes No_ <br /> ' Chain of custody agrees with sample labels? Yes ✓ No— <br /> Samples in proper container/bottle? Yes No <br /> ' Sample containers intact? Yes ✓ No— <br /> Sufficient sample volume for indicated test? Yes No <br /> ' All samples received within holding time? I ry Yes_ No_ <br /> Containerrremp Blank temperature in compliance(40 C±2)? Temp:—� I°C Yes ✓ No— <br /> Water- <br /> o_Water-VOA vials have zero headspace? No VOA vials submitted_Yes 1/ No <br /> (if bubble is present,refer to approximate bubble size and itemize in comments as S (small-O), M (medium— O)or L(large— O) <br /> ' Water-pH acceptable upon receipt? )l Yes ❑ No <br /> ' ❑ pH adjusted— Preservative used: /❑ HNO3❑ HCI ❑ H2SO4❑ N20H ❑ZnOAc <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 discrepancy(ies)] <br /> Project Manager: (initials) Date: ____L_/02 <br /> ' Client contacted: ❑ Yes ❑ No <br /> Summary of discussion: <br /> '• Corrective Action (per PM/Client): <br />