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Nlil _ „acv w,-,...�.--^+"� "'q"�"_""'"�y"s-z.s^•„ya-N+a["�'r-Y-�-mrd -^^r-�+-r y����� .+a-�r*.�...-� '"'-,�_.-•--r'r--^^t <br /> STmom L <br /> STL <br /> I <br /> STL Sari Francisco � <br /> Sample Receipt Checklist <br /> Submission #•2003- 1 6 _ 2 <br /> 3 <br /> ChBckhs 'V <br /> t completed by (initials)� Date 1 � 103 <br /> Courier name a STL San Francisco ❑Client—At, C>C 1� _ <br /> Not <br /> Custody seals intact on shipping containerfsamples , Yes Nn Present <br /> Chain of custody present? des moi'v�#a_ <br /> Chain Of custody skgRed when relinquished and receiveds <br /> Chain of custody agrees WO samp!e labels? YesNo <br /> Samples in proper containerlhattte" Yes No <br /> Sample dontainers intact` Yes No <br /> Sufficient sample volurrme,for indicated test) Yes_Z<Nq__ <br /> All sarripI6 rived w1thin holding time? (,(/_ Yes��No <br /> ContainerlTemp Blank temperature in cxampliance(4°C t 2)? Temp C yes_.----NO <br /> Ice Present <br /> • Water-VOA vials have-zeta ho_"spaeO No VQAviais slabmrtted Yes �o <br /> Cf bubble Is present refer to approximate bubbte size and Itemiza in comments as 5 (small-0), M(madlum - O)or L Marge- V) <br /> Water- pH acceptable upon receipt,? Yes ❑INo <br /> 0 pH adjusted- Preservative used- Q HNOa❑HCl CY HaSO4 El NaOH Q ZnoAc--Lot 4(s) <br /> For-any Item check-listed "No",provided detail,of discrepancy In comment section below: <br /> _ e <br /> �iiimrnents� - � - <br /> a ) <br /> PMarlatg6men#° Mdufing(#ol�in-;strUfioln of�inciicated dir,00F VdV000 <br /> Nrojad Manager On#tiata) <br /> Cllent=ntactedT ❑ Yes 0' No, <br /> Summary of.disaussion' <br /> F <br /> F n <br /> MCorrective Adan{per`PMI Crient)' <br /> I ' <br /> i <br />