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ACCUTEST= "Ccutest Laboratories Sample Receiptaryhyh{ <br /> Accutest Job Number:°C36711 Client: DVSERT Project: PACTRIPACKAGING RECT JUL 24 2015 <br /> Date/Time Received: 10/27/2014 8.48.00 AM Delivery Method: Accutest Courier Airbill#'s: <br /> Cooler Temps(Initial/Adjusted): #1(1.7/1.7} <br /> A <br /> Cooler Security Y or N Y or N Sample Integrity-Documentation Y or N <br /> 1.CustodySeals Present vl 3.COC Present: ❑ <br /> i.Sample labels present on bottles: <br /> 2.Custody Seals Intact1 4.Smpl DatesTme OK JI 2.Container labeling Complete: ❑ <br /> Cooler Temperature Y or N 3.Sample container label/COC agree: yl ❑ <br /> 1.Temp criteria achieved: V1 L Sample Integrity-Condition Y or N <br /> 2.Cooler temp verification: I112; ❑ <br /> 1.Sample recvtl within HT: <br /> 3.Cooler metlia: Ice(Bag)_._. .. <br /> 2.All containers accounted for: y7i ❑ <br /> 4.No.Coolers: 1 <br /> 3.Condition of sample: Intact <br /> Quality Control.Preservation Y or N NIA Sample lntearity-Instructions Y or N NIA <br /> L Trip Blank present/Cooler: L L V1 <br /> 1.Analysis requested is Gear: ® ❑ <br /> 2.Trip Blank listed on COC: L V 2.Bottles received for unspecified tests [] <br /> 3.Samples preserved property: ♦ C 3.Su661ent volume recvd for analysis: ❑ <br /> 4.VOCs headspace free: _. L 7 4.Compositing instructions Gear: ❑ ❑ 0 <br /> 5.Filtering instructions dear, ❑ ❑ 0 <br /> Comments <br /> pccNof laMNonn 3tre WMYAvanue San Jw.CA 95131 <br /> V40&569.0200 F'.4CB.500.eMt xlwlecMeY.cwn <br /> C36711: Chain of Custody <br /> Page 2 of 2 <br /> ■ i 9 of 19 <br /> a ACCUTEa-r <br /> C36711 <br />