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® STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> bmisslon # 2005- -per- <br />' Checklist completed by (initials �j��Date �. / 105 <br /> . ' <br />' Courier name . STL San Francisco ❑ Client <br /> Not <br /> Custody seals intact on shipping containerlsamples Yes No Present <br /> ' Chain of custody present? Yes �No <br /> Chain of custody signed when relinquished and received9 YesY,�-' No <br /> 1 Cham of custody agrees with sample labeis? 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 <br /> received within holding time? Yes r No <br /> }y 4QIanIC�t�TT@F t yr. <br /> P <br /> r r et E @ 47 '1 �i'ay 1 j ` �t:_et _soxe#�" �lnart�� <br /> k- it70 I- <br /> FIs x,," r r �.."" - s• -k �'?'rF�T'�Dr�'° r .,����� 7,7vE <br /> S "�z "' ,YpF'k� - <br /> ampled<4hr--ago'?❑ Ice°notregUit�d e it D b+�1 s e `���: �,� ' <br /> ' tce Present Yes No <br /> 101ter-VOR vials have zero headspace? No VOA vials submitted Yes__J- No <br /> ' (af bubble is present refer to approximate bubble size and itemize in comments as S (small -0), M (medium - O) or L (large-- 0) <br /> Water-pH acceptable upon receipt? ❑ Yes ❑ No <br /> 0 pH adjusted- Preservative used ❑ HNO3❑ HCI❑ H2SO4 ❑ NaOH ❑ ZnOAc-Lot#(s) <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 dlscrepancy(les)] <br /> Project Manager (initials) Date 1 105 <br /> ' Client contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> i <br /> Corrective Action (per PM/Client) <br />