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`ATL. <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> Submission #:2004- <br /> Checklist completed by:(initials) Date: 1 r 104 <br /> Courier name,- 01STL San Francisco ❑Client <br /> Not <br /> Custody seals intact on shipping container/samples Yes Ne Present <br /> Chaln of custody present? Yes t 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 containedbottle? Yes e----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 /> Container)Temp Blank temperature In compliance(49 C f 2)? Temp:4 I°C Yes No <br /> Ice Present Yes /No <br /> Water-VOA vials have zero head space? No VOA vials submitted Yes�o <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? 940S ❑No <br /> ❑ pH adjusted– Preservative used: ❑ HNO3❑HCl ❑ H2SO4❑NaOH❑ZnOAc–Lot#(s) <br /> For any item check-listed "No",provided detain of discrepancy In comment section below: <br /> Comments: <br /> Project Management [Routing for instruction of indicated discrepancy(ies)] <br /> Project Manager. (initials) Date-, / /04 <br /> Client contacted: ❑ Yes ❑ No <br /> Summary.raf.discussiorr <br /> :- _ - <br /> I <br /> Corredvb Action (per PM/Client): <br /> I <br /> i <br /> f <br />