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mmm STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> Submission #:2004- L 6, <br /> Checklist completed by: (initials) Date: �1_/04 <br /> Courier name STL San Francisco ❑ Client <br /> Not <br /> Custody seals intact on shipping container/samples Yes No Present <br /> Chain of custody present <br /> 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 No <br /> Sample containers intact? Yes ✓ No <br /> Sufficient sample volume for indicated test? Yes L--No <br /> All samples received within holding time? Yes ---No <br /> Container/Temp Blank temperature in compliance (40 C ±2)? Temp: r °C Yes f No <br /> Ice Present Yes e"—No <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 -O), M (medium , 0) or L (large j <br /> Water- pH acceptable upon receipt? Yes ❑ No <br /> ❑ pH adjusted-- Preservative used: ❑ HNO3 ❑ HCI ❑ H23O4 ❑ 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 discrepancy(ies)] <br /> Project Manager: (initials) Date: 1 104 <br /> Client contacted: ❑ Yes El No <br /> Summary of discussion: <br /> Corrective Action (per PM/Client): <br />