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STL <br /> STL San Francisco <br /> 0Sample Receipt Checklist <br /> Submission #'2004- 0 $ - d/& q <br /> Checklist completed by (initials) "— Date 0 g 1 Qf� 104 <br /> Courier name XSTL San Francisco ❑ Client Not <br /> Custody seals intact on shipping container/samples Yes No Present <br /> Cham of custody present? Yes '� No <br /> Cham of custody signed when relinquished and received? Yes `� No <br /> Chain of custody agrees with sample labels? Yes 110, 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 (4°C± 2)? Temp�L°C Yes No <br /> Ice Present 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 5 (small -O), M (medium 0) or L (targe O) <br /> Water-pH acceptable upon receipt? ❑ Yes ❑ No <br /> ❑ pH adjusted— Preservative used ❑ HNO3❑ HCl ❑ H2SO4 ❑ NaOH ❑ZnOAc—Lot#(s) <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(ies)] <br /> Project Manager (initials) Date 1 /04 <br /> Client contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> Corrective Action (per PM/Ghent) <br />