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--....-�. _ .. .. ———_ — —._.._.—-- —— '— — -- --- ^-^-.. �_ � < • m �+ r t ^,� �J i ,�'��.v°w L zx ti 4"tw^ ��ria.mkt.f��i�;�` 3; �° <br /> ' I <br /> MOMW ST L <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> Submission #.2004- _(`) Z_ <br /> Checklsst completed by (initials) ` " Dale f 1g4 <br /> ;.ourcer name ❑ STt_San Francisco ❑ Client A'6Not <br /> CUStoriy seals tn;ac;on shipping ccntame,fsarnpies I Yes No Present tl� <br /> Cham of custody present? Yes_yZNo <br /> Chain of custody signed when relinquished and received? � Yes--LINO <br /> Cham of custody agrees with sample labels' yes-1ZNo <br /> Samples in proper containerftttle? Yes, Na <br /> Sample containers intact Yes_4�_Wfo <br /> t Sufficient sample volume for indicated test'2 Yes_,:n�No <br /> All, samples received within holding time? Yes._ .�'No <br /> ConlainerfTemp Blame temperature in compliance(40 C t 2)? Te p r °C Yes ��No_ <br /> Ice Present Yes ✓No <br /> Water-VOA vials Have zero he dspacb T _ ___� _ - -No VOA vials bmitteO:: <br /> (if bLbale is present refer to approximate bubble size and itemize En comments as S (small--0), li� (medium — 0)or L(large— V) <br /> Wale -_pH accep <br /> tab e upon recatpt?—Iff Yes a No <br /> 0 pH adjusted— Preservative rased CI HNOz O HCI 0 H2SO4 Q NaOH O Zn4Ac—List#(s) <br /> For any Item check-listed "No", prov1ded detail of discrepancy In comment section below: <br /> Comments. <br /> Project Management [Routing for instruction of indicated discrepart y(ies)] <br /> Project Manager (initials) Date ! 104 <br /> Client contacted C1 Yes ❑ No <br /> Summary of discussion <br /> Corrective Action (per PNI/Client) <br /> t <br />