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STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> • D <br /> 61�. Submission #:2004_ / V <br /> Checklist completed by: (initials) / `� Date: 1 1 �/ 101 <br /> 1 Courier name: ❑ STL San Francisco rent <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 f o <br /> Chain of custody agrees with sample labels? Yes o <br /> Samples in proper container/bottle? Yes - No <br /> Sample containers intact? Yes e' No <br /> Sufficient sample volume for indicated test? Yes e No <br /> All samples received within holding time? Yes --IN o <br /> Container/Temp Blank temperature in compliance (40 C:t 2)? Temp.�L°C Yes--6,ZNO <br /> Ice Present Yes ,- No <br /> Ji4w ater-VOA vials have zero headspace? No VOA vials submitted Yes_,efL_`No <br /> (if bubble is present, refer to approximate bubble size and itemize in comments as S (small 40), M (medium -- O)or L(large- 0) <br /> lWater-pH acceptable upon receipt? 2Y/es ❑ 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: k 104 <br /> Client contacted: ❑ Yes ❑ No <br /> Summary of discussion: <br /> orrective Action (per PM/Client): <br />