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® STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> ,s lubmission #.2004- O S - 0 7SI <br /> 4 <br /> Checklist completed by: (initials Date: 104 <br /> Courier name-/ 4TL San Francisco 11 Client <br /> vvvvvv Not <br /> Custody seats intact on shipping container/samples Yes Ifo Present------ <br /> Chain <br /> resent'Chain of custody present? Yes No <br /> Chain of custody signed when relinquished and received? Yes f No <br /> Chain of custody agrees with sample labels? Yes / No <br /> Samples in proper containedbottle? Yes No <br /> Sample containers intact? Yes-4 No <br /> Sufficient sample volume for indicated test? Yes No <br /> All samples received within holding time? Yes--/—No <br /> n �F}TernBla �ltenperatu � oo t7cC �a tee. <br /> Y <br /> �r 2.- .. .�'._. .'_w - � -<_ .._ �-�ti_,,: x ;s��W��r N,t.. ,--�� .re..:.�._-:���' _Y,E_;���:•��»E-:: .,a�r.a�r? ...' ., -- -_ ,_ _ <br /> :Gax <br /> (: ater-VOA vials have zero heads ace? <br /> p 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– Q)or L(large-- O) <br /> Water-pH acceptable upon receipt? ❑Yes ❑ No <br /> ❑pH adjusted– Preservative used: ❑ HNO3❑HCl ❑ H2SO4❑ NaOH O ZnOAc–Lot#(s) <br /> For any item check-listed "No", provided detail of discrepancy in comment section below: <br /> Gomments: <br /> Project Management [Routing for instruction of indicated disc repancy(ies)] <br /> Project Manager: (initials) Date: 1 104 Client contacted: ❑ Yes ❑ No <br /> Summary of discussion: <br /> ': rrective Action (per PM/Client): <br />