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I <br /> ® STL <br /> STL San Francisco <br /> �1 Sample Receipt Checklist, <br /> Submission # 2005- - <br /> Checklist completed by (initlalslt= late. l J 105 <br /> Courier name C1 STL Sari Francisca Client <br /> Not <br /> Custody scaK Intact an shipping-ontainerlsamples Yes No preserat� <br /> Chain oFcuatvdypresent" <br /> yes l No <br /> Chain of cu-;Indy signed When relinquished and re(.eived? Yes /No <br /> Chain of LUslody agrees with sample tabels'� Yea No <br /> Samples in proper c*ntainer+bottle'? Yes / Na <br /> Snmple roolarnei$mtact'� Yes <br /> �"a <br /> Sufficient sample volume for indicated te! tX> yes / Nq <br /> All samples roc+Qiued%th,n ltolding time) Yes /-- No <br /> ContamerlTemp Blank ternperaturezin©ompUanceA(410`C�2f? I rb �"doe Yes <br /> Poten`t�al,reasntr'for>�6" rel tneltecl i7bleJ � � N <br /> l�e'r1 bags ❑ Natje� b'h'ice 0 Nal enoug e5n �axe <br /> 6� <br /> Sampled<4hr ago Ice,nat requireil,(e g_air roc bulk safpr'e� <br /> • Ice {'resent Yes ,eL"" <br /> Water VOA vials have zero heudspace? Poo VOA vials s bmitted_ _ Yes_ N <br /> r <br /> (if bubble is present, refer to approximate bubble size and itemize in comments as S(small-0) M (medium- 0)or L(iarge - 0) <br /> %Alater-pH acceptable upon receipt? Q Yes ©No <br /> ©WH adjusted- Preservative used ❑ HNO3 ❑HCI© H2SQ4 ❑ NaOH 0 ZnOAc-Lot#(s) i <br /> For any itern check listed "No', provided detail of discrepancy in comment section below_ <br /> Comments <br /> t <br /> Project Management [Routing for instruction of Indicated dlscrepanc (les)] <br /> Project Manager (initials) ©ate ! I05 r <br /> Client contacted ❑ Yes ❑ No <br /> surnmary of discussion <br /> i <br /> I <br /> Corrective Action(per PMIChent) <br /> I <br />