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mum STI <br /> STL San Francisco <br /> iSample Receipt Checklist~ <br /> Submission #,2003- IQ_+(y <br /> Checklist completed by (Initials)4 Date l / _/w <br /> Courier name ❑ STL San Francisco 0 Client <br /> Not <br /> Custody seals intact on shtpping containerlsamples Yes No Present_ <br /> Chain of custody preseNry Yes--i,—/NQ-- <br /> Chain of custody signed when relinquished and recalled? Yes L.--No <br /> Chain of custody agrees with sample labels' Yes No <br /> Samples In proper container/battle? yes---,No 3 <br /> Semple containers intact? Yes ✓No___ <br /> Sufficient sample volume for indicated test? Yes ✓r No <br /> All samples received within holding time? Yes_ZNo <br /> Container/Temp Blank temperature to compliance(40 C 12)? T mp C Yes, , No <br /> i <br /> Ice Present Yes _No <br /> Water-VOA vials have zero headspace? No VOA vials ubmttted Yes—Z No <br /> i <br /> (if bubble is present, refer to approxirnate bub le size and Itemize to comments as S (small--0), (medium— O)or I.(large_ 0) 1 <br /> Water- pH acceptable upon receipt? es © No f <br /> ©pH adjusted— Preservative used 0 HN0317 MCI 0 HzSOa 0 NaOH 0 ZnOAc—Lot#(s) <br /> For any Item check-listed "No", provided detail of discrepancy In comment section below <br /> Comments- <br /> Protect Management [Routing for instruction of indicated discrepan y{les)] <br /> Pro)ect Manager- �lnittals) Date 1 103 <br /> Client contao.ed ❑ Yes ❑ No <br /> Summary of discussion <br /> Cormcttve Action(per PWCiaent) <br /> I <br /> i <br /> i <br />