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® STS, <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> Submission #:2004- 0 - 0,308' <br /> Checklist completed by (initials) '` ` ' Date 01 I_L:�,/04 <br /> Courier name ❑ STL San Francisco ❑ Client A?C— JZ , <br /> Not <br /> Custody seals intact on shipping container/samples Yes No Present---L/— <br /> Chain <br /> resent---LChain of custody present? Yes No I <br /> Chain of custody signed when relinquished and received? Yes/ No <br /> Chain of custody agrees with sample labels? Yes__ZNo , <br /> Samples in proper container/bottle? Yes .! No <br /> Sample containers intact? Yes_ _No j <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 t 2)? Temp_°C Yes ✓No <br /> Ice Present Yes No i <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 S(small--O), M (medium — O)or L (large — O) <br /> Water-pH acceptable upon receipt? V es ❑ 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(les)] <br /> Project Manager (initials) Datil / 104 <br /> Client contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> Corrective Action (per PM/Ghent) <br />