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Sample Receipt Checklist STL San Francisco <br /> Submission #: 2002.-)_ <br /> Checklist completed by: (initials) Date: / /02 <br /> Courier name: 19 STL San Francisco ❑ Client Not / <br /> Custody seals intact on shipping container/samples Yes No Present v <br /> ' Chain of custody present? Yes ✓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? Yeses No= <br /> Sufficient sample volume for indicated test? Yes No <br /> All samples received within holding time? Yes /No= <br /> Container/Temp Blank temperature in compliance(40 C+2)? Temp e°C Yes v No— <br /> Water <br /> o <br /> Water-VOA vials have zero headspace? No VOA vials submitted_Yes 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? ❑Yes ❑ No <br /> ' ❑pH adjusted- Preservative used: ❑ HNO3 ❑ HCl ❑ HZSO, ❑ NaOH❑ 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: !02 <br /> ' Client contacted: ❑ Yes ❑ No <br /> Summary of discussion: <br /> Corrective Action (per PM/Client): <br />