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I <br /> l <br /> SI <br /> 1, <br /> STL San Francisco � <br /> Sample Receipt Checklist <br /> Submission # 2005- () ( ()() <br /> € i,J'Ib, ("ratpleled by (Insl�jls) � � Cute <br /> t uuii-r r,nmr i 1 SIL Sar, FranrtscoCherli <br /> Nnt <br /> L la lr,C,yr Intact ren shrppinct r.onlatncrJsamples � Yes Nva Present <br /> chdtu,of rus,ody present,t Mes a <br /> Cham of ru,tudy i fried when reNngiJt5lied and rec-elved? Yea ! No <br /> OW,111) (if C-WA0,ly 3gfCi 5 I rlth sernpre labels" Yes ! No µ <br /> S�mples <br /> in prkiper rontatnerrbottl�'? Yes X10 <br /> Yes��c� <br /> Sut,ictent san We Volunye for indicated test) Yes ❑ <br /> All ,ampIcs received valhin nclding IsmO J Yes„ N© <br /> Contarneri l cmp Blank temperature in coo trance 00 C i2)? <br /> Potential reasonto OT -ica m ttect 0� l n gs L7 Not= of E�Iice-40t riot-ei� ,iii 't�e 0�ISampi sin ti e © <br /> Sanioted<Sar agn— cenot,ragrerred,{e,g-'4trforbulk s'ampid),t3 <br /> / lcb Present Yes,_ o <br /> Wete,-VC)A vials have Zero hcedspace7 No VOJ1 vials s ibmitted ^ Yes No <br /> (ti buUble :s present, refer to approximate WUL)le stte and Itemize rr,comments as S(small-0), (medrurn - 0) or L(large- 0 t <br /> Walet-pH acceptable upon receipts ©Yes ❑No <br /> © pH adjusted- Preservative used 0 HNOa U HG1 © HzSOi 0 NaOH Q ZnOAa-Lct#(s) <br /> For any stern check-hated "No". provided detail of discrepancy to comment section;Wow <br /> , <br /> Comments <br /> Project Management (Routing for instruction of indicated discrepanc (les)] <br /> Manager- intttals) <br /> Project tate —1 fps <br /> 3 rJ { - <br /> Client contacted, M Ye-,. 0 No <br /> r <br /> Summary of dtycumoil <br /> , <br /> 3 <br /> Corrective Action (per PfWChent) � <br /> € <br /> 1 <br />