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STL CHROMALAB <br /> - <br /> IMMMMMW <br /> ErmrMunotw Sffmce{sael <br /> Q Sample Receipt Checklist <br /> Client Name Date/Time Received <br /> Date / Time <br /> Reference/Subm # Received by <br /> Checklist completed by � 04 k Reviewed By <br /> Signature / Date Initial/Date <br /> Matrix ❑ Soil ater Other Carrier name Client - C/L - <br /> / Not <br /> Shipping container/cccler in good condition's Yes ✓ No Present <br /> Not <br /> Custody seals intact on shipping container/cooler' Yes No— Present <br /> Not / <br /> Custody seals intact on sample bottles'? Yes No Present V <br /> Chain cf custody present's Yes v No <br /> Chain of custody signed when relinquished and received> Yes-1ZNo <br /> Chain of custody agrees with sample labels' Yes No <br /> Samples in proper container/bottle'? Yesy No <br /> Sample containers intact' Yes No <br /> Sufficient sample volume for indicated test? Yes No--* <br /> i � <br /> A.1 samples received within holding time? Yes No <br /> Container/Temp Blank temperature in compliance) Temp °C Yes '-� No <br /> Water - VOA vials have zero headspace'? No VOA vials submitted Yes No <br /> Water - pH acceptable upon receipt"J ❑ Yes ❑ No ❑ Checked by Voa chemist <br /> ❑ pH ad)usted- Preservative used <br /> ❑ HNO3 ❑ HC1 ❑ HZSOQ ❑ NaOH ❑ ZnOAc Lot# (s) <br /> Any No and/ox NA (not applicable) response must be detailed in the comments section below <br /> Client contacted Date contacted Person contacted <br /> Contacted by Regarding <br /> Comments 1', �� �� \V��, �'� — <br /> Corrective Action <br /> fonnslsample controllsmprechk 2001 doc <br />