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M! STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> 6ubmission # 2004- 0 - __:;4 _- <br /> Checklist completed by (initials) Date '-/JAI 104 <br /> Custody <br /> ouriername ElSTL San Francisco ❑ Client—A g0, QD�1 Q, Not <br /> y seals intact on shipping container/samples Yes No Present <br /> Chain of custody present? Yes ✓"No <br /> Chain of custody signed when relinquished and received? Yes 4-�No <br /> Cham of custody agrees with sample labels? Yes No <br /> Samples in proper container/bottle? Yes_JZNo <br /> Samnlp containers intact? Yes ,,- No <br /> Sufficient sample volume for indicated test? Yes L----No <br /> ' All samples received within holding time? Yes -'---No <br /> Container/Temp Blank temperature in compliance(4)C±2)? Temp �- °C Yes /No <br /> J,L <br /> Ice Present Yes—le-4— <br /> Water <br /> es-_ otoWater-VOA vials have zero headspace? No VOA vials submitted Yes ✓No <br /> Pfbubble is present, refer to approximate bubble size and itemize in comments as S (small --O), M (medium -- Q)or L(large - O) <br /> Water-pH acceptable upon receipt? 6 Yes ❑ No <br /> © pH adjusted- Preservative used ❑ HNO3 ❑ HCI ❑ H2SO4 ❑ NaOH ❑ ZnOAc-Lot#(s) <br /> For any item check-listed "No", provided detail of discrepancy in comment section below <br /> \ r <br /> Comments P c; � yock A k`rl o ��Q'n�z LO 'r� CAI) V) <br /> Project Management [Routing for instruction of Indicated discrepancy(ies)] <br /> Project Manager (initials) S Dail 01 -/ ��/04 <br /> Client contacted 2itYes ❑ No <br /> rSummary of discussion i h V a Y3 V}gd _w^ci., ,/ `7p�,,,� so."T <br /> �rrrective Action (per PM/Client) <br />