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® STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> d 1 <br /> Submission # 2004- 0s1-1 2 <br /> r1 <br /> Checklist completed by (initials) mate 1 ZI 104 <br /> Courier name ❑ STL San Francisco ❑ Client llC <br /> Custody seals intact on shipping container/samples Not <br /> Yes No Present <br /> Chain of custody present? Yes f� <br /> Chain of custody signed when relinquished and received? Yes /No— <br /> Chain <br /> NoCham of custody agrees with sample labels') - Yes_�No <br /> Samples in proper container/bottle? Yes ----No <br /> Sample containers intact? Yes ---"Na <br /> Sufficient sample volume for indicated testi Yes ef�No <br /> All samples received within holding time? Yes No <br /> Container/Temp Blank temperature in compliance (40 C t 2)? Temp!?=C Yes No <br /> Ice Present Yes._LN/co <br /> Water-VOA vials have zero headspace? No VOA vials submitted Yes_ZNo <br /> (if bubble is present, refer to approximate bubble size and itemize in comments as S (small-O), M (medium -- O)or L(large-- <br /> Water- pH acceptable upon receipt? Yes ❑ No <br /> .0 plladjusted�Preservative_used �❑ HNO3 ❑_WC!_❑ H2SO4❑ NaOH 13 ZnOAc—Lot##(s)— <br /> Foran item check-listed "No", provided detail of dis_crepancy_rn comment section below <br /> Comments _— <br /> Project Management [Routing for instruction of indicated discrepancy(les)] ; <br /> Project Manager (initials) !S'S Date' C) 1 1 o)oti104 <br /> Chent contacted 211*'Yes ❑ No <br /> Summary of discussion �� y.. ctn f1'JA, �y ` <br /> Corrective Action (per PM/Client) <br /> i <br />