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1 Maxxam Analytics Inc. <br /> BRL FCD-00051/1 <br /> ' SAMPLE RECEIPT LOG Page 1 of 1 <br /> Lab Name: Maxxam Analytics Inc.,Burlington Laboratory <br /> Pickup/received by(Name): <br /> Pickup/received by(Signature): Date:a1 j 71 ime: /oZ.3 p ra <br /> ' Client Project ID: 9� <br /> Where Applicable: <br /> ' Shipment: <br /> Courier Compgny: : FEDEX•N UPS ❑ DHL Q, PurolatoF ❑ BAX p Other <br /> Waybill#: 5;3 ,el _ :;Z 772 -/k 79 <br /> ' Assigned job#!: •A <br /> Client Name: <br /> ' Client Contact: Ch r -D�Lt/1 S <br /> RL f.9XgS' ,; `s , �''r, , ;�.T�� .;; �Conrdttron of Sairiple(s)Shipment=Co»i` is <br /> Sample§Packed in Coolers? 4 Yes ip3r No❑ N/A ❑ j <br /> Coolertontains ice? Yes l§ No❑ N/A❑ <br /> ' Custody seal(s)on cooler? Yes❑ No N/A❑ <br /> I'M ,7 .S4.iVple Recep.,Ron Documenfahon`= <br /> Date& Tune received at Lab? Yes /No❑ N/A ❑ <br /> (CoQ of Custody(Copresent? Yes U N ❑ N/A ❑ <br /> Cooler Temperature measured? Yes 19 No❑ N/A ❑ ' <br /> Containers intact? Yes/ No❑ N/A ❑ <br /> Correct containers used? Yes P o❑ N/A D <br /> CoC agrees with samples? Yes 0 No B'N/A ❑ <br /> Headspace present in VQC vials? Y,,s❑ No❑ N/A <br /> Samples rec.`d after hold time? Yes❑ No WN//A <br /> / ❑ <br /> Project'Mgr contacted via SIF? Yes(9 No ❑ <br /> ' "` s; =_P,ro�ectSun'"agerpocumeniutzon.r ,aT`' <br /> Client contacted if discrep'ancies~w Yes❑ No❑ N/A O <br /> in shipment are observed <br /> Client acceptance ofdefeeienci& " Yes❑ No❑ N/A ❑ <br /> (if observed at sample recei t <br /> Cooler temperbtures-upon receipt <br /> Cooler ID: Temp. o <br /> Cooler ID: Temp. <br /> Cooler ID: Temp. <br /> j <br /> Relinquished by: Date: <br />