Laserfiche WebLink
® STt <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> ubmission # 2004- laZ - d 5-i?/ <br /> Checklist completed by (initials) kw Date IC-A- 1 104 <br /> Courier name ❑ STL San Francisco Client <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 J No <br /> Chain of custody agrees with sample labels? Yes `� No <br /> Samples in proper container/bottle? Yes No <br /> Sample containers intact? Yes No <br /> Sufficient sample volume for indicated test? Yes No <br /> All samples received within holding time? Yes No <br /> ContainerfTemp Blank temperature in compliance(40 C±2)? Temp `0 °C Yes '� No <br /> Potential reason for a 6°C-Ice melted ❑ Ice in bags ❑ Not enough ice 0 Not enough blue ice ❑ Samples in boxes❑ <br /> Sampled <Or ago?❑ Ice not required (e g air or bulk sample) ❑ J <br /> Ice Present Yes 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-- 0) <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(les)] <br /> Project Manager (initials) Date 1 104 Client contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> Oorrective Action (per PM/Client) <br />