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STL <br /> STL San Fran Isco <br /> Sample Receipt Checklist <br /> Submission 1:2004- tq-7- 0"o <br /> t <br /> Checklist compZSSan <br /> (Initials)� Date �1 ��104 <br /> Courier name Francisco ❑Client <br /> Not <br /> Custody seats Intan shipping containertsamples Yes No Present <br /> Chain of custody pre ant? Yes_ef. <br /> �No <br /> Chain of custody sig ed when rellnquished and recenred7 yes—e: hto <br /> Chain of custodyag es with sample labels? Yes r"No, <br /> Samples to properi ntarnerftllle'? Yes No <br /> Sample oantalners i tact? Yes No <br /> Sufficient sample vo me for indicated test' Yes C. No <br /> All samples receive within hoiding Uma? Yes r/ No <br /> Container/Temp$la k temperature in compliance(40 C±2)? Te mp�-c Yes/�No_, <br /> Ice Present Yes / o <br /> Water-VOA vials ha a zero headspace? No VOi4 vials ubmrtteq Yes !/ No <br /> M 1 [� <br /> (if bubble rs present, efer to approximate bubble size and itemize:in comments as S(small-O), (medlum- U)or L(large- 0) <br /> I <br /> Water-pH accepts le upon recelpt? ❑Yes ❑ No <br /> ❑pH adjusted- P servative used ❑HNOa❑14CI❑I-f2SOc Cl NaOH d ZnOAc-Lit ts(s) <br /> Forany Item chat rated "No",provided detail of discrepancy In commentsection etaw <br /> Comments , <br /> Project Manag ment [Routing for Instruction of indicated discrepan y(ies)] <br /> I <br /> Project Manager fir+ttals� Date f 104 1 <br /> Client contacted Yes ❑ No { <br /> Summary of discusron <br /> 3 <br /> C orrectwe Action(p PIJIIClrent) <br /> 7 <br /> I <br /> I <br />