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STL San Francisco, ' <br /> Sample Receiipt/t Checklist M <br /> Submission # 2005 <br /> clZeckilst completed by BATE <br /> Courier STL SF Courier f—I Fedex UPS Other Client_ <br /> Log-In Details Yes No Comments <br /> 9 1Custodv seals intact on shipping containerlsamples µ - <br /> 2 Chain of custody present? <br /> 3 Chain of custody signed when relinquished and received? P.-k.d Up at Secure Location ' <br /> # I Client signed off at Isme prior to pick up <br /> 4 All samples checked when GOC relinquished <br /> 5 Chain of custody agrees with sample labels? <br /> 6 Samples in proper containerlbottle? <br /> 7 Sample containers intact? <br /> 8 Sufficient sample volume for indicated test? <br /> 9 All sample6 received within holding time? <br /> Cooler Temperature Compliance Check <br /> Temperature Blank Reading Cooler Sample Temperature J <br /> tf no trip blank is submitted #4 92 1 #3 Average <br /> individual temperatures must <br /> - - <br /> be tatien as per SOP <br /> Reason for Elevated Temperature Samples with Temp>VC-Comments <br /> F— -Ice Melted r Insuffic-ent Ice [— <br /> r Samp in boxes r Sampled <4hr Ice not req <br /> VOA Sample Inspection <br /> Small Med Lar e <br /> Samples with broken, <br /> Sample# 0 O � cracked or leaking containers <br /> Are bubbles �rtasent in any of the VOA F- r F <br /> vials ? <br /> F F r <br /> r- F- <br /> Yes No Samples with Unacceptable pH <br /> Water-pH acceptable upon receipt? f— F <br /> 0 pH adjusted— Preservative used ❑ HNO3❑ HCI ❑ H2SO4❑ Na-OH ❑ ZnOAC—Lbt#(s) <br /> Comments <br /> Project Management [Routing for instruction of indicated discrepancy(ies)] <br /> Project Manager (initials) ____ Cate 1 !05 Client contacted Yep Nr <br /> 0 <br /> Summary of discussion <br /> Corrective Action (per PM/Client) <br /> ]oils Cneckrar ver zo <br />