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® S T L <br /> 5TL San Francisca <br /> r Sample Receipt Checklist <br /> 911 <br /> Submission #-2003- [ a - � <br /> Checklist Yinitials <br /> ( )�completed b Date 1" ! r 3103 <br /> P <br /> Courier name ❑ STL San Francisco 0 Client or <br /> Not <br /> Custody seals intact on shipping containedsampies Yes No Present <br /> Chain of custody present? Yes�Fla <br /> Chain of custody signed when relinquished and receivedYes�i�o <br /> Chain of custody agrees with sample labels? Yes 6 <br /> Samples in proper container/bottte? Yes No <br /> Sample containers intact? Yes �No_ <br /> Sufficient sample volume for indicated test? Yes_ZNo - <br /> Ali samples received%nthin holding time? Yesef-fiNo <br /> ContainerlTemp Blank temperature in compliance(4°C ±2)? Temp /'(,AC Yes ��Na <br /> Ice Present Yes No <br /> Water-VOA vials have zero headspace? No VOA vials submitted Yes <br /> (if bubble is present,refer to appro)amate bubble size and itemize in comments as S (small—0), M(medium— 0)or L(large— O) <br /> Water-pH acceptable upon receipt? es 0 No <br /> ❑ pH adjusted— Preservative used ❑HNO3 ❑ HCI 0 H2SO4 0 NaOH 0 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 1 103 <br /> Client contacted 0 Yes 0 No <br /> Summary of dISCUS5lon <br /> Corrective Action (per PM/Client) <br />