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+an <br /> L rSTL <br /> . Francisco <br /> Sample Receipt Checklist <br /> Submission #.2004- o5' <br /> e <br /> Che klist completed by (initials) i Date -f-1 -�7 X104 <br /> Coui ier name A STL San Francisco ❑ Client f%> ii}t•t prk. <br /> Cusl Ddy seals intact on shipping containerlsamples Riot <br /> Yes No Present W'- <br /> Chai n of custody presents Yes No <br /> Chai i of custody signed when relinquished and received? Yes ✓ No <br /> Cha of custody agrees wild sample labels? Yes No <br /> Sa les in proper containerlbolile? Yes--Z_No <br /> Safr Ple containers intact? Yes_ / No I <br /> Su lent sample volume for Indicated lest.? <br /> Yes L_No <br /> All s inVles received within holding time? Yes No <br /> Con alnerrremp Blank temperature in compliance(40 C 2)? Temp ' °C Yes lE/f No <br /> Ice Present Yes lz Rio <br /> Wawa-VOA vlais have zero headspace? No VOA vats;submitted Yes /F No <br /> 7 <br /> (f bi ibble is present,refer to approximate bubble size and Itemize in comments as S (arrrali-0),M (medium- O) or L(large- U) <br /> that r-pH acceptable upon receipt? ❑ Yes O No <br /> 44 pl 11 adjusted- Preservative used 0 HNOz 0 HCl❑H2SO4❑NaOH© ZnQAc-Lot#(s) <br /> For ny item check-listed "No",provided detail of discrepancy In comment section below- <br /> Comments: <br /> elow-Cca ments- <br /> i <br /> Pr 'ect Management [touting for instruction of indicated discrop;atney(les)] <br /> Pro t Manager; ((nifials) tate 1 104 <br /> I <br /> Cliet t contacted Cl Yes Q No <br /> Se many of dmmussran <br /> Corr actirve Action(per PMIClient) <br /> r <br />