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MGM STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> submission #:2004- /0 - <br /> Checklist completed by: (initials) )Dsl " Date: �� I q IO4 <br /> Courier name: ❑ STL San Francisco XGlient <br />` Not <br /> L Custody seals intact on shipping container/samples Yes No Present <br /> Chain of custody present? Yes-4 No <br /> L Chain of custody signed when relinquished and received? Yes—/—No <br />[ Chain of custody agrees with sample labels? Yes ✓No <br /> i` L <br /> Samples in proper containerlbottle? Yes No <br /> Sample containers intact? Yes ✓ No <br /> ✓ <br /> Sufficient sample volume for indicated test.? Yes No <br /> All samples received within holding time? Yes No <br /> .;:: " pe {, ? :- , ". i, fir +-^ c „ <br /> Gon ainerT,emp Blank#emperature in eom;p.(iance (4 C 2) , � � rP ernp C 1"esg,: ar No zr <br /> � ^: - +' a .53� ca .:.n� -.:t4�. <br /> k s _ u.. "�"" '§' <br /> CPotei#�atreasonsfor?6 Gklcernelfedtl Ic ,in,b �s 17, ,;Not nbh,c �❑a Not�en�uglue:�ceb ,'Samles�n,bo�fsL7 ..Y . <br /> � a :..ter.,,'�irk;...s�."� h _�"��€_a,_ � „ „�,.'rta.,., e §, f� ��=t' z,€ F:, 'r'�� ..�-'�r. °.:�a+r"'s -�4�"�b»�";g-. a` ,...-c7k •`5 �§ -,,'.�. <br /> � i ' Ick Psnt ` esx N , <br /> LVater-VOA vials have zero headspace? No VOA vials submitted Yes ✓No <br /> (if bubble is present, refer to approximate bubble size and itemize in comments as S (small-O), M (medium - O) or L(large- 0) <br /> Water- pH acceptable upon receipt? ❑ Yes ❑ No <br /> ❑ pH adjusted- Preservative used: ❑ HNO3❑ HCI ❑ H2SO4❑ NaOH ❑ZnOAc-Lot#(s) <br /> For any item check-listed "No", provided detail of discrepancy in comment section below: } <br /> LComments: <br /> C L <br /> Project Management [Routing for instruction of indicated discrepancy(ies)] <br /> Project Manager-. initials Date: 1 /04 Client contacted: ❑ Yes ❑ No i <br /> ! 9 (initials) <br /> Summary of discussion: <br /> lorrective Action (per PMIClient): <br />