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r STL San Francisco <br /> Sample Receipt Checklist I <br /> Subir I nission #.2008- 00 { <br /> Checkllsted i completed by <br /> . aArE 3; <br /> Courter. r STL SF Courier f r } <br /> fFade f UPS Ocher Cti;nt <br /> I to -In'Detatls 4 Yes Na/ Comments <br /> Custody seals Intact on shipping containerlsamples € <br /> 2 Chain of custo�y present? I l <br /> 3 Chain of Custody signed when relinquished and received? a# eau <br /> • � t Ct�l1 ff=�tC�OR e![[TI9 Or,ar la DY.'i ap <br /> 4 All samples chfcked when COC relinquished ' { <br /> � f <br /> S Chain or custody agrees vnth sample labels? <br /> C� <br /> 6 Samples in prober can#ainerlbattie s ,rt <br /> 7 Sample contalrjers frltact? <br /> 8 Sufficient samr,le volume for indicated testi f � <br /> J �1 <br /> q All samples rer�lved within holding time? j <br /> t <br /> Cooler Temperature Compliance check i <br /> Tern arature Blank Reading Gooier Sampte Tem eraturd <br /> If tm«.p pI�Lk ti aa,b,rlind <br /> ILL[f14"4LIg7 IampnrrdLl/h7 mil"S t 1 * Js#31 Avdra e <br /> be lakers Ws y)ar SOP i <br /> Reason for Elevated Temperature <br /> Samples—WE Te <br /> -ice w48ltpd Insulficlent Ice <br /> mp 6�c-comrrlcrets <br /> Same sn bows F Sampled -c Or rce taot req <br /> 1 VOA Sam le inspoctlan F <br /> 1 Small Med Lara <br /> Samples with broken, <br /> Sample# 0 r1 J Cracked or leaking containers <br /> Are bubbles Pres nt to any of the VOA V III <br /> vills ? <br /> Water•pH aecep i ble Upon receipt? Yes No Sampies wlthiUnacceptable pH <br /> r r- <br /> Cl pH adjusted- Preservative Used © HNO,❑ HCI El 1-I2SO,, © NaOH-D ZnOAIc—La!`;f(s) <br /> Conaniernts 1 <br /> r <br /> Project Mana eme [Routinq fol'instruction of indicated discre panc les <br /> Project Manage (initials) Date 1 106 Client contacted Yef— NF— <br /> Summary of discussion <br /> Corrective Action (per PM1CIlent) <br /> T.r.S CM[kLf7 Vn Z 0 <br /> fyl` <br /> f <br />