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�•CCUTEST Accutest Laboratories Sample Receipt Summary <br /> LABORATDRIEB <br /> Accutest Job Number: C25653 Client: KLEINFELDER Project: COSTCO-Lodi,CA <br /> Date/Time Received: 1/9/2013 Delivery Method: Accutest Courier Airbill#'s: <br /> Cooler Temps(Initial/Adjusted): #1:(5.7/5.7): D <br /> Cooler Security Y or N Y or N Sample Integrity-Documentation Y or N <br /> 1.Custody Seals Present: ❑ © 3.COC Present: W ❑ 1.Sample labels present on bottles: © ❑ <br /> 2.Custody Seals Intact: ❑ ❑ 4.Smpl Dates/Time OK ] ❑ 2.Container labeling complete: ® ❑ V7 <br /> Cooler Temperature Y or N 3.Sample container label/COC agree: 0 ❑ <br /> 1.Temp criteria achieved: © ❑ Sample Integrity-Condition Y or N <br /> 2.Cooler temp verification: IR GunEl1.Sample recvd within HT: <br /> 3.Cooler media: Ice(Bag) 2.All containers accounted for: © ❑ <br /> 4.No.Coolers: 1 3.Condition of sample: Intact <br /> Quality Control_Preservation Y or N N/A Sample Integrity-Instructions Y or N NIA <br /> 1.Trip Blank present/cooler. ❑ ❑ 0 ❑ <br /> 1.Analysis requested is clear: Sa <br /> 2.Trip Blank listed on COC: ❑ ❑ R 2.Bottles received for unspecified tests ❑ R) <br /> 3.Samples preserved property: ❑ ❑ 3.Sufficient volume recvd for analysis: 0 ❑ <br /> 4.VOCs headspace free: ❑ ❑ © 4.Compositing instructions clear: ❑ ❑ 0 <br /> 5.Filtering instructions clear: ❑ ❑ <br /> Comments <br /> Accutest Laboratories 2105 Lundy Avenue San Jose,CA 95131 <br /> V:408.588.0200 F:408.588.0201 —damutest—in <br /> C25653: Chain of Custody <br /> Page 2 of 2 <br /> M® 12 of 17 <br /> M OM( U-rEO-r <br /> C25653 "`°a..°""° <br />