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HOUSTON LABORATORY <br /> 8880 INTERCHANGE DRIVE <br /> . HOUSTON[,TEXAS 77054 <br /> O (713)650-0901 <br /> Sample Receipt Checklist <br /> Workorder 00030103 Received by Stelly,D'Anna <br /> Date and Time Received 313100 10 00 00 AM Carver name FedEx <br /> Temperature 2 <br /> Shipping container/cooler in good condition? Yes ❑ No❑ Not Present ❑ <br /> Custody seals intact on shippping containerlcooleO Yes ❑ No❑ Not Present 0 <br /> Custody seals intact on sample bottles? Yes ❑ No❑ Not Present Sa <br /> Chain of custody present? Yes © No❑ <br /> I Chain of custody signed when relinquished and received? Yes ❑ No❑ <br /> Chain of custody agrees%nth sample labels? Yes © No❑ <br /> Samples in proper containerlbottle? Yes No❑ <br /> Sample containers mtact? Yes © No❑ <br /> 1 Sufficient sample volume for indicated test? Yes © No❑ <br /> All samples received within holding time? Yes No❑ <br /> e;ontainerrFemp Blank temperature in compliance? Yes © No❑ <br /> Water-VOA vials have zero headspace? Yes No❑ Not Present ❑ <br /> IWater-pH acceptable upon receipt? —Yes No❑ - <br /> I <br /> I <br /> I� <br /> I <br /> i <br /> 1 <br /> 1 <br />