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' Sample Receipt Checklist STL San Francisco <br /> Submission #: 2002- Qco O5 3 <br /> Checklist completed by: (initials)�� D Date: / 2r/ /02 <br /> ' Courier name: bST��L San Francisco ❑Client Not <br /> Custody seals intact on shipping container/samples <br /> Yes_No Present <br /> Yes�No_ <br /> ' Chain of custody present? <br /> Yeses��lo_ <br /> Chain of custody signed when relinquished and received? <br /> Yes�o_. <br /> ' Chain of custody agrees with sample labels? — <br /> Yes �No <br /> Samples in proper container/bottle? <br /> Yes o_ <br /> ' Sample containers intact? — <br /> Yes No <br /> Sufficient sample volume for indicated test? <br /> Yes!No_ <br /> ' All samples received within holding time? <br /> Temp°C YesZNo_ <br /> Container/Temp Blank temperature in compliance (40 C±2)? <br /> No VOA vials submitted_Yes�No_ <br /> Water-VOA vials have zero headspace? <br /> ' <br /> ts as S (small -O), M (medium - 0)orL(large- O) <br /> (if bubble is present, refer to approximate bubble size and itemize in commen <br /> Water-pH acceptable upon receipt? ❑Yes ❑ No <br /> ' O pH adjusted- Preservative used: ❑ HNOs❑ HCI ❑ H2SO4 ❑ NaOH ❑ZnOAc <br /> For any item check-listed "No", provided detail of discrepancy in comment section below: <br /> ' Comments: <br /> ------------ <br /> ' Project Management [Routing for instruction of indicated discrepancy(ies)] <br /> Project Manager: (initials) <br /> Date: / DZ <br /> ' Client contacted: ❑ Yes ❑ No <br /> Summary of discussion: <br /> ' Corrective Action (per PM/Client): <br />