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ST L <br /> STL San Francisca <br /> ample Receipt Checklist <br /> (5- <br /> Submission #:2004- <br /> (2-, <br /> :2gC14- <br /> Chatkltsl cam leled b�&jn <br /> i's!s <br /> i p n ti ) 1 " " Date. l � I04 <br /> Couriar name: STl Francisco 0 Client <br /> Nol <br /> Custody seals intact nn shipping con Iainerlsampies Yes No— Presenl_ <br /> Cham of custody preseni7 <br /> Chau of Custody signed when relinquished and received? Yes o� <br /> Chall of cu5tady argrees.wiith sample Ilaba.ls? Yos. ___-Z <br /> Samles in proper container/bottle? <br /> Yes No <br /> Sarale containers tnlact? Yes --No <br /> GutA�iant sample volume for Indicated test? <br /> f R Yes No <br /> All simples received within holding lime? Yes '-<o <br /> Cantlriv,I emp dank temperature in compliance( °C t }? `hemp; ° Y. f jo <br /> Ice Present Ysis -4o -- <br /> Wat�r-VOA vials have zero hoadsPWO? No VOA vials submitted Yes , o ';...,. <br /> (if babble Is present,refer to approximate bubble size.and ilentizeln comments as S(shall--0), fN(rhedium-- 0)or tr(la(ge- ). <br /> 'Nat r-pH acceptable upon rcccipt? D`fes 0 Na <br /> 0 PM, aajusted-- preservativ©used: 0 HN%0 Hot J HzSO„q Nao.H D�nOAa-Lot#(s)- <br /> For>by Iter check-listed "No",provided dtWil of'dt wepancy In cdrlimortt sectido hjelow; <br /> Cbttll�etlis: <br /> Prai'elvt Manq;gOment. [Rout ng #ar instruction of indicated dt cre ancy� es ] <br /> Prof of Managar: (initials) mate. 1 104 <br /> Uiei ikiontacWd! d 16s C] No <br /> Surr rrma :ofdiswaston;. <br /> Corri Olve,Action(per PM/Mlerit): <br /> e <br /> F <br />