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® STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> SSubmission #.2003- © - dc�� Z <br /> Checklist completed by (initials) /Ki �D � / 103 <br /> Courser name ❑ STL San Francisco lent_ <br /> Not <br /> Custody seals intact on shipping container/samples Yes No Present <br /> Chain of custody present? Yes L.1<0 <br /> Chain of custody signed when relinquished and received? Yes _,"No <br /> Chain of custody agrees with sample labels? Yes o-' 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__,e!:�'No <br /> Container/Temp Blank temperature in compliance (40 C t 2)? Temp "&°C Yes L----1To <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- Q) <br /> Water-pH acceptable upon receipt�es ❑ No <br /> ❑ pH adjusted- Preservative used ❑ HNO3 ❑ HCI ❑ H2SO4 ❑ NaOH ❑ ZnOAc <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 dlscrepancy(les)] <br /> Project Manager (initials) Date 1 103 <br /> Client contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> Corrective Action (per PM/Client) <br />