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® STL <br /> STL San Francisco <br /> Sam p a Receipt Checklist <br /> lOubmission # 2004- � <br /> Checklist completed by (initials) Date r �/ ?7 /04 <br /> Courier name ❑ STL San Francisco lient <br /> Not _ / <br /> Custody seals intact on shipping container/samples Yes No Present W, <br /> Chain of custody present? Yes (�No <br /> Chain of custody signed when relinquished and received? Yes t, IVo <br /> Cham of custody agrees with sample labels? Yes ---No <br /> Samples in proper containerlbottle? Yes No <br /> Sample containers intact? Yes l o <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;t 2)? Temp °C YesZNo <br /> Potential reason for 7 6°C-Ice melted ❑ Ice in bags ❑ Not enough ice ❑ Not enough blue ice ❑ Samples in boxes ❑ <br /> Sampled <Or ago?❑ Ice not required (e g air or bulk sample) Irl <br /> Ice Present Yes No <br /> later-VOA vials have zero headspace? No VOA vials submitted Yes_.ZNa <br /> (if bubble is present refer to approximate bubble size and itemize in comments as 5(small,-O), M (medium-- O) or L(large— O) <br /> Water- pH acceptable upon receipt? ❑ 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 /> Comments <br /> Project Management [Routing for instruction of indicated discrepancy(ies)] <br /> Project Manager (Initials) Date 1 104 Client contacted ❑ Yes 0 No <br /> Summary of discussion <br /> Oorrective Action (per PM/Client) <br />