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® STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br />%Submission # 2003- 0l - C)-� <br /> Checklist completed by (initials) N[ Date of 12-1 103 <br /> Courier name ❑ STL San FranciscoIEent <br /> Not <br /> Custody seals intact on shipping container/samples Yes No Present <br /> 1# Chain of custody present? Yes ,--"N o <br /> Chain of custody sig q signed when relinquished and received? Yes____, No <br /> Chain of custody agrees with sample labels? Yes L-_"No <br /> Samples in proper containerlbottie? Yes �No <br /> / <br /> E Sample containers intact' Yes v No <br /> Sufficient sample volume for indicated test? YesVI'No <br /> All samples received within holding time? Yes �No <br /> Container/Temp Blank temperature in compliance (40 C +2)? Temp_&L0 C Yes v�No <br /> Water-VOA vials have zero headspace? No VOA vials submitted Yes No <br /> {af bubble is present, refer to approximate bubble size and itemize in comments as 5 (small—O) M (medium — O) or L (large -- ®) <br />'00 <br /> Water-pH acceptable upon receipt? t-'Yes ❑ No <br /> ❑ pH adjusted— Preservative used ❑ HNO3 ❑ HCl ❑ H2SO4 ❑ NaOH ❑ ZnOAc <br /> For any item check-listed "No", provided detail of discrepancy in comment section below <br /> Comments �C3L (YZ��R 15 ��� 1 <br /> Project Management [Routing for instruction of indicated dtscrepancy(tes)] <br /> Project Manager (initials) Date 1 103 <br /> Client contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> Corrective Action (per PM/Client) <br />