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HOUSTON LABORATORY <br /> 8880 INTERCHANGE DRIVE <br /> HOUSTON TEXAS 77054 <br /> ® (713)660-0901 <br /> Sample Receipt Checklist <br /> Workorder 00020060 Received by Barrera Nancy <br /> Date and Time Received 212100 10 00 00 AM Carrier name FedEx <br /> Temperature 2 <br /> Shipping containericooler in good condition? Yes No❑ Not Present ❑ <br /> Custody seals Intact on shippping container/cooler? 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 0 No❑ <br /> Chain of custody agrees with sample labels? Yes No❑ <br /> Samples in proper container/bottle? Yes No❑ <br /> Sample containers intact? Yes No❑ <br /> Sufficient sample volume for indicated test? Yes 0 No❑ <br /> All samples received within holding time? Yes 0 No❑ <br /> Container/Temp Blank temperature in compliance? Yes No❑ <br /> Water-VOA vials have zero headspace7 Yes 0 No❑ Not Present ❑ <br /> Water-pH acceptable upon receipt? Yes No❑ <br />