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f <br /> ITL San Francisco <br /> Sample ReceiptChecklist <br />' Submission #-2005- --Dg <br /> y f rSr 7 � <br /> t LCE7B�sliti5t BpinIete�l'by 1iA5` <br /> _ - <br /> ' Courier- STL SF Courier rl Fedex UPS Other Client <br /> Logon Details Yes No Comments <br /> Custody seals intact on shipping containerlsamples <br /> 2 Chain of custody present? <br /> / P,Cketi Up at Secure Location <br /> 3 Chain of custody signed when relinquished and received? <br /> CSienl vgnetl off al I,me pnor to pick up <br /> 4 All samples checked when COC relinquished <br /> 5 Chain of custody agrees with sample labels? <br /> 6 Samples in proper containerlbottle? <br /> 7 Sample containers intact? <br /> 8 SuffictenE sample volume for indicated test? <br /> 9 All samples received within holding time? <br /> ' Cooler Temperature Compliance Check <br /> Ternperature Blank Reading Cooler-Sample Temperature <br /> i<np Inp blank�s 5ubmtlteC 41 #!2 #3 - Average_ <br /> inti mcuai temperatures musl <br /> be taken as per SOP <br /> Rgason`for revatpd Temperature Samples with Ternp>6°C -Comments <br /> Ice Melted lnsuffiuent Ice <br /> ' Samp in boxes Sampled< 4hr Ice not req <br /> VGA Sample inspectiop <br /> -- - Small Ned Uar` - - <br /> _ _bptMpte_�!_avith brokers, <br /> J _ _ Sample 40 <br /> O a crack dor-7eakirigcontarners <br /> Are bubble-s present:Wi` i)y-ofthO V0AS° f-- F_ <br /> -lies No _0jhpl,eswlth-Aac_ceptaVe pH <br /> Water-pH acceptable'irponi xeceipt7 r-" 1 <br /> ❑ pH adjusted- Preservative used ❑ HNO3 © HCI ❑ H2S0a❑ NaOH ❑ ZnOAc-Lot#(s) <br /> Comments <br /> Project Management (ftout+ng for instruction of indicated discrepancy(ies)] <br /> Project Manager (initials) Cate 1 105 Client contacted YeF- Nr <br /> Summary of discussion <br /> Corrective Action (per PM/Client) <br /> 50051:ch-Mal ver S0 <br />