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�i- <br /> ® STL <br /> { �STL. San Francesca <br /> Sample Receipt Checklist <br /> Submission #.2003- _- Q C L73 <br /> Checklist completed by (initials) T1- bate <br /> Courier name ❑ 5TL San Yranc:sco 0 Client J <br /> Not <br /> Custody seats intact on snipping containerisamples Yes No Present <br /> Chain of custody present) Yes f/N'o <br /> Chain of custody signed when reEinquished and received? Yes ✓ IVa <br /> Chain of custody agrees%vdih samoie labels? Yes-4 No <br /> Samples in proper contatneabottle-7 Yes /No <br /> Sample Containers intact? Yes-Z—No <br /> Sufficient sample volume for indicated test? Yes_No _ <br /> Ali samples received within voiding time? Yes f No_ <br /> Container/Temp Blank temperature to compliance(40 C:2)'? Te np ad2OC Yes/No <br /> Ice Present Yes_ Ia� <br /> Water-VOA vials have zero headspace? No VOA vials s Libmitted— Yes—/—No <br /> ! <br /> (if ouable is present refer to approximate bubble size and itemize En comments as S (small-0) IV, finedwrn - 0)or L(large- V) f <br /> t <br /> +Nates-pH acceptable upon mcelpt7 r1 Yes C No <br /> U` pH adjusted-- Preservative usea 0 HNC3 C HCl❑ ri;SO,C NaCH C ZnCAc-Lot#(s) <br /> For any Item check-listed "No", provided detail of discrepancy in comment section below <br /> Comments- <br /> Project Mann [Routing for instruction of indicated discrepant y(les)] <br /> o�ect 9 emen# <br /> P,01ect Manager (tnittals)_. gate_ 1iG3 <br /> C,ientcantacteld 0 Yes G NO <br /> Summary of dlscusaron <br /> Corrective Actlon(per PMIC-Ient) <br /> z <br />