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® STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> 41ibmisslon #:2004- <br /> Checklist completed by (initials) V` Date _/ a '7J04 <br /> Courier name XSTL San Francisco ❑ Client <br /> Not <br /> Custody seals intact on shipping container/samples Yes No Present <br /> Chain of custody present? Yes ✓ No <br /> Chain of custody signed when relinquished and received? Yes ✓ No <br /> Chain of custody agrees with sample labels? Yes No <br /> Samples in proper container/bottle? Yes f No <br /> Sample containers intact? Yes No <br /> Sufficient sample volume for indicated test? Yes / No <br /> All samples received within holding times ,L Yes / No <br /> Container/Temp Blank temperature in compliance (40 C±2)? Temp " ' .0 Yes -,' No <br /> Ice Present Yes ✓ No <br /> Water-VOA vials have zero headspace? No VOA vials submitted Yesl_No <br /> • <br /> (if bubble is present, refer to approximate bubble size and itemize in comments as S (small -O), M (medium— Q) or L(large— 0) <br /> Water-pH acceptable upon receipt? Z Yes ❑ No <br /> ❑ 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 0A 00A <br /> a f z <br /> + uJ <br /> Project Management [Routing for instruction of indicated dlscrepancy(ies)] <br /> Project Manager (inibals) Date 1 J04 <br /> Client contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> �rective Action (per PM/Client) <br />