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somm ZEM <br /> T L <br /> TL San Francisco <br /> Sample Receipt Checklist <br /> Submission #:2003• - <br /> Checklist ccrnplefed by, Cinitials) 0�mW Date- 05 J �-&103 <br /> Courier name: M STI, Son rrancAsoo_ Client <br /> Nat <br /> Custody seals intact on shippirq con#ainer amples Yes. Na Present <br /> Chain of custody present? Yes G No <br /> Chain aP cusxody signet)when relinquished amd received? Yes No <br /> Chairs of custody agrees with sample labels? Yes No <br /> Samples in proper coaiainedboftle? Yes No <br /> Sample Cont irl rs intact? 3 Ax Yves_ cr No <br /> utFcien#somple volume for Indicated test" i Yas No <br /> All samples receiVed voithin Balding time? + ; Yep r No <br /> Contalnorffernp Blank'temperature in complij�n6e (4)C 12)? Temp- `C Yes ► No� <br /> Water -VOA vi;�l!�have zero headspace?' No VOA vials submitted Yes_ 4ZNo <br /> (if bubble is present, refer to approximWQ� hubhle size and itemize In comments as S (small-O), M (medium- )or L{large- ) <br /> Water-pH acceptable upon reoelpt?xYes ❑ No <br /> 0 pH adjusted- PreservWiva used: 0 HNIOj ❑ HCI M H2SO4 0 NaOH 0 ZnOAc <br /> For any item check-listed "No", provided detail of dfsereparrcy in comment section below: <br /> Comments- <br /> Project Management [Routing for instruction of indicated discrepancy{ies)l <br /> Project Maflager- (initials) Date JU3 <br /> Ghent contacted- ❑ Yes CI No <br /> Summary of rfisctission; <br /> Ccrrecrive Action (per PMfCliemt) <br />