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HOUSTON LABORATORY <br /> 8880 INTERCHAM1tG>=BREVE <br /> HOUSTON TEXAS 77054 <br /> (713)660 0931 <br /> Sample Receipt Checklist <br />' Workorder 04020792 Received By DS <br /> i <br /> Date and Time Received 2128101 9 30 00 AM Carrier name FedEx <br /> Temperature 3 Chilled by <br /> Shipping container/cooler in good conditions Yes No _ Not present <br />' 2 Custody seats intact on shippping containericooler? Yes — No l__. Not Present Vol <br /> 3 Custody seals intact on sample bottles? Yes F-- <br /> No L-- Not Present �! <br /> 4 Chain of custody present? Yes No <br /> t5 Chain of custody signed when relinquished and received? Yes V No — <br /> 6 Chain of custody agrees with sample labels? Yes No <br /> 7 Samples in proper container/bottle? Yes Ne <br /> 10 8 Sample containers intact? es � No - <br /> 9 Sufficient sample volume for indicated test? ves ti <br /> 10 All samples received within holding time? ves IN/ tic <br />' 11 Container/Temp Blank temperature in compliance? Yes No <br /> 12 Water-VQA vials have zero headspace? Yes No Not Applicable <br /> 13 Water-pH acceptable upon receipt? Yes ice' No L Not Applicable <br /> SPL Representative T _ T Contact Date &Time - <br /> ' Client Name Contacted - - - <br /> Non Conformance <br /> t Issues - - - - -- - -- -- -- -_- - — _------ - _ - -- _- - <br /> Client Instructions <br /> 01020792 Page 19 <br /> 3119131 2 03 55 PM <br />