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HOUSTON LABORATORY <br /> 8880lNTERCHANGE DRIVE <br /> R <br /> HOUSTON TEXAS 77054 <br /> ' (713)660-0907 <br /> Sample Receipt Checklist <br /> vVarkorder � 01050390 <br /> Received By NB <br /> Date and Time Received 5112101 10 00 00 AHE <br /> Carrier name FedEx <br /> ' Temperature 4 Chilfed by Water Ice <br /> Shipping container/cooler in good condition? Yes No Not Present <br /> 2 Custody seals intact on shipppmg container/cooler? Yes _ -- <br /> No � Not Present <br /> 3 Custody seals Intact on sample bottles? Yes No _ Not Present <br /> 4 Chain of custody present? - <br /> ' Yes '✓' No <br /> Chain of custody signed when relinquished and received? Yes k No _ <br /> 6 Cham of custody agrees with sample labels? Yes J <br /> No _ <br /> �7 Samples in proper container/bottle? ves No - <br /> ' 8 Sample containers Intact? Yes No <br />' 9 Sufficient sample volume for indicated test? Yes No _ <br /> 10 All samples received within holding time? Yes <br /> Na <br /> Container/Temp Blank temperature in compliance? Yes No <br /> 12 Water-VOA vials have zero headspace? Yes " No Not Applicable <br /> 13 Water-pH acceptable upon receipt? Yes No - Not Applicable <br />' SPL Representative - -� Contact Date &Time - <br /> Client Name Contacted <br /> Non Conformance -- - — --- - -- - - <br /> Issues <br /> Client Instructions <br /> 0105039() Page 23 <br /> 5123101 8 16 25 AM <br />