Laserfiche WebLink
' STL <br /> STL San Francisco <br /> a Sample Receipt Checklist <br /> ,ubmission #;2004- /10 <br /> ' Checklist completed by: (initials) S`" Date: /O 1104 <br /> Courier name: ❑ STL San Francisco ` Client <br /> Not <br /> ' Custody seals intact on shipping container/samples Yes No Present <br /> Chain of custody present? Yes—/—No <br /> ' Chain of custody signed when relinquished and received? Yes No <br /> ' Chain of custody agrees with sample labels? Yes ✓No <br /> Samples in proper containerlbottle? Yes ✓ No <br /> Sample containers intact? Yes ✓ No <br /> Sufficient sample volume for indicated test? Yes No <br /> ' All samples received within holding time? Yes No <br /> ..;. :.,. �tFrM,rte.^, ,.*sc--,gyp,-n �` � <br /> C,ont9inerTfemp Blank t mperafur�xin colrrp ance;(4,,�c 2) *� Tempel <br /> fa`^' ' 9 .%,,s.t'.`« A •.y € i� �i^�`'$" t s `' �" ;, « - f. s '„fit % n ;K;3:' - ; <br /> � 'fie a f , <br /> is� <br /> ON t", <br /> � : <br /> (f?otentrat.reason for r? C -;Itis melted fl E,ceain ba s HO Notenou hlre� C!, :I�ot enou M".biue ice ❑ "Sam les in�bo�es D �� �5=��''; <br /> --.�_.....�� c. :tre.a,r�. -�3�,�" ;€ � �:.set'•'.,s�-: � Wm� � '�`,� z' _ ,�R � ,.:� �a€�,'?fa �. E.;.z 3.r J ty� �-�a9'"E�,a?a "xri p�.`..a 3�` - '�'�` ��" <br /> xr� ' �.'k':' ':." � "-� � � p'�"^n. •�, e'e: `r`�<�,.Ydy3._y�'�:.�`':S_:rv'q-.., a.�f.- t� `a,��;,` ��c�' Sia t �`r !�1�" p. :";:-,��+ a ,%+.v,, <br /> �' f �� �& a� r ��, ,r �.€'�� tk:. �5`'` � � �'<� ��` �;'�'7-' nY"� ' �L �; '�•^ ;� lce P�sBFlt nYES� 1+��0'r `r <br /> 'O" Vater <br /> -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-- O) <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 /> Comments: <br /> ' Project Management [Routing for instruction of indicated discrepancy(ies)] <br /> Project Manager: (initials) Date: 1 !04 Client contacted: ❑ Yes ❑ No <br /> ' Summary of discussion: <br /> Ororrective Action (per PM/Client): <br /> dl <br /> 1 <br /> i' . <br />