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I ® S T L STL San Francisco Sample Receipt Checklist 0l Submission # 2004- _f v - Q3C7e ' Checklist completed by (initials) Date /10 / 104 Courier name STL an Francisco ❑ Client Not � Custody seals intact on shipping container/samples Yes No Present 1 Chain of custody present? Yes No Chain of custody signed when relinquished and received? Yes / No Chain of custody agrees with sample labels? Yes 4--'-N-o Samples in proper container/bottle? Yes —No Sample containers intact? Yes No Sufficient sample volume for indicated test? ` YesNo All samples received within holding time? Yes o Container/Tem `Blank em eratu i s7c' }§ pp P rg n—,7c' =CE ,2)? L }� ,�. .vx" , b uy�,�4 'rSj,'i, 1atx. � �3.e.J ° mp C Sar Ci114ViN��r ,s4 ¢y p'.,.,,. +s;> %3 +b a rX9.r f e 3 i' g i,x,fY"rEr ate a E F „� 4dd+ m � r w jf E *a 3p Poterit altreaso'n for B°C tl ', I w _ s � , r a fE C �eltedbl=3 11ce mba s 0 Not e oui e ❑ �v - i SPE ,, � rx � 9_ < gt1 e Not, blue ace ❑ {Samples_�n boxesal;! E r E'z �I:.yfj�r¢4a {y, ;?E; TtjEfW`E x'�4�' c'$,,A w k as a 3tE", I E� Sam Eed E�4hr, a 0? I aka y L, M'4 ,4r ?4 p g v? ❑x,�Jce not re utr e� air ogbUIk sa p '' �-§t '��3``�i s� �"� -,f n.f ye; �'^}" ,� E v �". A r_E k 'F + n, t mss, �awi�° � = S IceeP,resent Yes Water-VOA vials have zero headspace? No VOA vials submitted Yes No 1 (€f bubble is present, refer to approximate bubble size and itemize in comments as S (small -O), M (medium-- Q) or L (large O) ' Water-pH acceptable upon receipt? ❑ Yes ❑ No 1:1pH adjusted- Preservative used ❑ HNO3❑ HCI ❑ H2SO4 11 -NaOH ❑ ZnOAc Lot#(s) P For any item check-listed "No", provided detail of discrepancy in comment section below Comments 1 Project Management [Routing for Instruction of Indicated dlscrepancy(Ies)] Project Manager (initials) Date / 104 Client contacted ❑ Yes © No Summary of discussion .Oorrective Action (per PM/Client)