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1 <br /> HOUSTON LABORATORY <br /> 8880 INTERCHANGE DRIVE <br />' HOUSTON TX 77054 <br /> (713) 660 0901 <br />' Sample Receipt Checklist <br />' Workorder 01090831 Received By RE <br /> Date and Tir-ne Received 9/26/01 10 00 00 AM Carrier name <br /> Temperature Chilled by <br /> 1 Shipping container/cooler in good condition? Yes [JJ No--v Not Present <br /> 2 Custody seals intact on shipppmg container/cooler? Yes 7 No Ld Not Present # <br /> 3. Custody seals intact on sample bottles? Yes _ No LSI Not Present f <br /> 1 4 Chain of custody present? Yes No k <br /> 5 Chain of custody signed when relinquished and received? Yes — No�/' <br /> 6. Chain of custody agrees with sample labels? Yes _ No V- <br /> 7 <br /> 7 Samples in proper container/bottle? Yes No <br /> 10 <br /> Sample containers intact':' Yas _ No <br /> 9 Sufficient sample volume for indicated test? Yes No <br /> Q All samples received within holding time? Yes _ No 1 <br /> I11 Container/Temp Blank temperature in compliance? Yes No <br /> 12 Water-VOA vials have zero headspace? Yes No'J Not Applicable L� <br /> 13 Water-pH acceptable upon receipt? Yes I No EI Not Applicable J <br /> SP!_ Representative Contact Date &Time <br /> Client Name Contacted -- ---- - _ -- - - -- ----- - - J- <br /> Non Conformance <br /> Issues <br /> Client Instructions <br /> I <br /> X012101 3 +545 PM <br /> I <br />