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® STL <br /> �-�M San Francisco <br /> Sample Receipt Checklist <br /> qubmission # 2003- <br /> _ o L_1��T <br /> initials Date l" / 1103 <br /> Checklist completed by { ) <br /> Couner name D STL Sari Francisco © Client CX- Not <br /> Custody seals intact an shipping cc)ntainer/sampies Yes No Present <br /> Chain of custody present? Yes L f- O <br /> Chain of custody signed when relinquished and received? Yes f�No <br /> Chain of custody agrees with sample labels? Yes / Na <br /> Samples in proper containerlbattle? Yes { No <br /> �Na <br /> Sample containers intact? Yes <br /> Sufficient sample volume for indicated test? Yes r No _ <br /> All samples received within holding time? Yes No <br /> CentainerlTemp Blank temperature to compliance (40 C+ Z)? Temp ly6 Yes No <br /> Ice Present Yes <br /> Water- VOA vials have zero headspace? No VOA vials submitted Yas, No <br /> 10 <br /> (if bubble is present refer to approximate bubble size and itemize in comments as S (small -O), M (medium 0) or L(large - L!) <br /> Water- pH acceptable upon receipt? es ❑ No <br /> ❑ pH adjusted— Preservative used ❑ HNOi ❑ HCI ❑ H7SO4 ❑ NaOH ❑ZnCAc—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 discrepancy(tes)] <br /> Project Manager (initials) Cate /03 <br /> Client contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> Oorrective Action (per PM/Client) <br />