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SAM , <br /> STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> tubmission # 2004- 0/ - 0 7-0.3 <br /> Checklist completed by (initials) _ Date ^1104 <br /> Courier name ® STL San Francisco ❑ Client <br /> Not <br /> Custody seats intact on shipping container/samples Yes No Present V <br /> Chain of custody present? Yes__ZNo <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 containedbottle? Yes ✓ No <br /> Sample containers intact? Yes '� No <br /> Sufficient sample volume for indicated test? a Yes V No <br /> All samples received within holding time? Yes `� Na <br /> ContainerlTemp Blank temperature in compliance(40 C t 2)? Temp5-Q °C Yes_Z No <br /> Ice Present Yes�No <br /> Water-VOA vials have zero headspace? No VOA vials submitted Yes ✓ No <br /> • <br /> (if bubble is present, refer to approximate bubble size and itemize in comments as S (small -O), M (medium - O)or L(large- O) <br /> Water-pH acceptable upon receipt? 1K <br /> I fyes ❑ 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 <br /> Project Management [Routing for instruction of Indicated dlscrepancy(Ies)] <br /> Project Manager (initials) Date 1 104 <br /> Client contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> �rrective Action (per PM/Client) <br />