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® STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br />%Ubmission # 2004- - 0-5-11— <br /> Checkiist completed by (initials) Nf Date 1 104 <br /> Courier name ]Q STL San Francisco ❑ Client <br /> ' ( Not <br /> Custody seats intact on shipping container amples Yes Present <br /> o_ <br /> ' Chain of custody present? Yes�o <br /> Chain of custody signed when relinquished and received? Yes No <br /> Cham of custody agrees with sample labels? Yes /�No <br /> in proper p <br /> Samples container/bottle? Yes , No <br /> Sample containers intact? Yes�o <br /> Sufficient sample volume for indicated test? Yes�o <br /> All samples received within holding time, Yes__ZNo <br /> ContairierNmp,Blank temperature in compliance (40 Cx± 2)� 'x z s Temp °C Yes ' I Nom <br /> Potential reason for> 6°C- Ice melted 0_Ice In bags 10_ Not enough ice ❑ Not enough blue ice 0 Samples in'boxes 0 <br /> Sampleclr` 3r ago?❑ Ice not required(e g'.air or bulk sample)gCl " ZN <br /> Ice Present= Yes <br /> �ater-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 5 (small --0) M (medium — 0) or L(large-- 0) <br /> ' Water- pH acceptable upon receipts ❑ Yes ❑ No <br /> ❑ pH adjusted Preservative used 0 HNO3 0 HCl I❑ H2SO4 0 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 dtscrepancy(ies)] <br /> Project Manager (initials) Date 1 104 Client contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> ,� rrective Action (per FPM/Client) <br />