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STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> submission # 2005---�- - ( 91 !�) 2 <br /> Checklist completed by (initials)4�Date 1105 <br /> Courier name ❑ STL San Franciscolol�_Client lT <br /> Not <br /> Custody 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 �No <br /> Chain of custody agrees with sample labels? Yes No <br /> Samples in proper container/bottle? Yes—ZNo <br /> Sample containers intact? Yes— o <br /> Sufficient sample volume for indicated test? Yes�o <br /> All samples received within holding time? / Yes- -.-No <br /> ContamerlTemp Blank temperature in compliance (40 C±2)? Temp / °C Yes -'�No <br /> Potential reason for> 5'C -Ice melted ❑ Ice in bags ❑ Not enough ice ❑ Not enough blue ice ❑ Samples in boxes ❑ <br /> Sampled <4hr ago?❑ Ice not required (e g air or bulk sample) ❑ / <br /> Ice Present Yes r 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 S (small --O), M (medium -- O) or L(large- 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 1 104 Client contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> 0-orrective Action (per PM/Client) <br />