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HOUSTON LAE30RATORY <br /> 8880 INTERCHANGE <br /> DRIVE <br /> HOUSTON TEXAS 770547054 <br /> �9,.703WR0000r <br /> (713}660 0901 <br />' Sample Receipt Checklist <br /> Workoidei 00110263 Received by Steliy DAPna <br /> Date and TEme Received 1119140 10 00 00 AM Carrier name FedEx <br /> Temperature 4 <br /> Shipping container/cooler to goad condttton'� Yes JNo Not Present <br /> Custody seals vitact on shippping container/cooler? Yes No _ Not Present <br /> Custody seats intact en sample potties? Yes No _ Not Present W <br /> Chain of custody present" Yes J No _ <br /> Chain or custody signed when rehnquisned and leceived? Yes J No <br /> Chain of custody agrees with sample labeis? Yes No <br /> Samples in groper container/bottle? Yes No <br /> Sample containers intact? Yes No <br /> ' Sutttctent sample volume for indicated test-' Yes J No — <br /> All samples received vtthtn holding times Yes J' No <br /> POntatnei/Tenip Blank `emperature in compliance' Yes V No <br /> Water ADA pals lave zero heacspuce Yes J No Not Present <br /> Water prl accep°able poen rP,,ipf Yes J No <br />