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s STL <br /> STL San Francisco t <br /> Sample Receipt Checklist <br /> Submission #:2003- 06 - <br /> Checklist completed by: (initials) Date: lld3 <br /> Courier name: 0 STL San Francisco ❑ Client ZZ ���- ` Not <br /> Custody seals intact an shipping containerlsamples Yes ✓ Na Present <br /> Chain of custody present? Yes ~fNe <br /> Chain of custody signed when relinquished and received? Yes �o <br /> Chain of custody agrees with sample labels? '�j� ,(,SCJ Yes No <br /> Samples in proper container/bottle? <br /> r �`y Yes f No <br /> 1 �` �/ � <br /> Sample containers intact.7 �%� Yes V" No <br /> Sufficient sample volume for indicated test? <br /> Yes No <br /> YesNa <br /> All samples-received within holding time? es_ <br /> No— <br /> Container/Temp Blank temperature in compliance (40 C=2)2 <br /> Temp' C Yes <br /> Water-VOA vials have zero headspace? No VOA vials submitted Yes ✓ No— <br /> (If bubble is present, refer to approximate bubble size and itemize in comments as S (small—0), M <br /> medium— 0) or L(large -- 0) <br /> Water- pH acceptable upon receipt? ii1 Yes 0 No <br /> El pH adjusted— Preservative used: ' ❑ HNO3❑ HCI 0 H2SO4 ❑ NaOH ❑ ZnOAc <br /> For any item oheck-listed "No", provided detail of discrepancy in comment section below: <br /> Comments: <br /> Project Management [Routing for instruction of indicated discrepancy(ies)] <br /> Project Manager: (initials) Date: 1-/C3 <br /> Client contacted: ❑ Yes 0 No <br /> Summary of discussion: <br /> Corrective Action (per PM/Client): <br />