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I / r <br /> HOUSTON LABORATORY <br /> Sao IWEDFIVE <br /> IRCHANGE <br /> HOUSTON,TEXAS 77054 <br /> ® (713)660-0801 <br />' Sample Recel t Checkllst <br />' Workorder 99120311 Received by Stelly,D'Anna <br /> Date and Time Received 12/10199 10 00 00 AM Camer name FedEx <br />' Temperature b <br /> Shipping container/cooler in good condition? Yes © No E] Not Present El <br /> Custody seals intact on shippping container/cooler? Yes ❑ No❑ Not Present ❑./ <br /> Custody seals intact on sample bottles? Yes ❑ No❑ Not Present 91 <br />' Chain of custody present? Yes 0 No ❑ <br /> Chain of custody signed when relinquished and received? Yes No ❑ <br /> Cham 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 No❑ <br /> All samples received within holding time? Yes © No❑ <br />'Oontainer[Temp Blank temperature in compliance? Yes No❑ <br /> Water-VOA vials have zero headspace? Yes No❑ Not Present ❑ <br /> Water-pH acceptable upon receipt? Yes No❑ -�� — <br /> li <br />