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HOUSTON LABORATORY <br /> 8880 INTERCHANGE DRIVE <br /> HOUSTON TEXAS 770" <br /> (773)660-0901 <br /> Sample Receipt Checklist <br /> ' Workorder 00020358 Received by Stelly D'Anna <br /> Date and Time Received 2112/00 10 00 00 AM Camer name P <br /> edE <br /> ' Temperature b <br /> Shipping container/cooler in good condition? Yes ❑d No ❑ Not Present ❑ <br /> Custody seats Intact on shippping containerf000ler? Yes ❑ No ❑ Not Present <br /> ' Custody seals intact on sample bottles? Yes ❑ No ❑ Not Present <br /> Chain of custody present? Yes No ❑ <br /> ' Chain of custody signed when relinquished and received? Yes No ❑ <br /> Chain of custody agrees with sample labels? Yes ❑ No ❑ <br /> ' Samples in proper container/bottle? Yes ❑d No ❑ <br /> Sample containers intact? Yes 0 No [] <br /> ' Sufficient sample volume for indicated test? Yes No ❑ <br /> All samples received within holding time? Yes FV1 No ❑ <br /> Container/Temp Blank temperature in compliance? Yes No ❑ <br /> Water-VOA vials have zero headspace7 <br /> Yes No ❑ Not Present ❑ <br /> Water-pH acceptable upon receipt? Yes d❑ No <br /> 1 <br /> 1 <br />