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Sample Receipt Checklist STL San Francisco <br /> Submission #• 2002- _ - 1�3 <br /> Checklist completed by (initials) Date <br /> Courier name ❑ STL San Francisco L5'Client <br /> Not <br /> Custody seals intact on shipping container/samples Yes No Present <br /> Chain of custody present? Yes✓est4o <br /> Chain of custody signed when relinquished and received? Yesy.,t:�'No <br /> Chain of custody agrees with sample labels? Yes_�No <br /> Samples in proper container/bottle? Yes 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 (40 C y 2)? Tern pe°C Yes "� No <br /> Water-VOA vials have zero headspace? No VOA vials submitted Yes '-"-No <br /> (if bubble is present, refer to approximate bubble size and itemize in comments as S (small -0) M (mecium - Q)or L (large- 0) <br /> Water-pH acceptable upon receipt'? ❑ Yes O No <br /> © pH adjusted- Preservative used ❑ HNO-3 ❑ HCI ❑ HzSO4 Gi NaOH ❑ ZnOAc <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 disc repancy(Ies)] <br /> Project Manager (initials) Date 1 102 <br /> Client contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> Corrective Action (per PM/Client) <br />