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Man STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br />%Submission # 2003- Of - 0'34 <br /> Checklist completed by (initials) N Vl Date V L- —12_103 <br /> Courier name ❑ STL San Francisco Client <br /> Not <br />` Custody seals intact on shipping containerlsampies Yes No Present V <br /> Chain of custody present? Yes /'No <br /> Chan of custody signed when relinquished and received? <br /> Yes I/No <br /> Chain of custody agrees with sample labels? Yes ✓ No <br /> Samples in proper container/bottle') Yes /No <br /> Sample containers intact? Yes V 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 + 2)? Temp_UDC Yes ✓No <br /> / <br /> Water-VOA vials have zero headspace? No VOA vials submitted V Yes No <br /> (if bubble is present refer to approximate bubble size and itemize in comments as S (small -O), M (medium — 0) or L (large — 0) <br /> 5 <br /> Water-pH acceptable upon receipt? ❑ Yes ❑ No <br /> ❑ pH adjusted— Preservative used ❑ HNOa© HCl ❑ H,SOa ❑ 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 discrepancy(les)] <br /> Project Manager (initials) Date 1 103 <br /> Client contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> Corrective Action (per PM/Client) <br />