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1534 Willow Pass Road, Pittsburg, CA 94565-1701 M C C a m b e I I Analytical . --Inc. Toll Free Telephone: (877) 252-9262 / Fax: (925) 252-9269 "When Oualitv Counts" I http://www.mccampbell.com / E-mail: main@mccampbell.com Sample Receipt Checklist Client Name: NJ McCutchen, Inc. Yes ❑ No ❑ Date and Time Received: 12/6/2011 6:15:00 PM Project Name: Paint Chips & Grinding Dust Samples Yes W No ❑ Checklist completed and reviewed by: Maria Venegas WorkOrder N°: 1112175 Matrix: Solid Yes 0 No ❑ Carrier: Courier Chain of Custody (COC) Information Chain of custody present? Yes W No ❑ Chain of custody signed when relinquished and received? Yes .i❑ No ❑ Chain of custody agrees with sample labels? Yes W No ❑ Sample IDs noted by Client on COC? Yes No ❑ Date and Time of collection noted by Client on COC? Yes No ❑ Sampler's name noted on COC? Yes No ❑ Custody seals intact on shipping container/cooler? Shipping container/cooler in good condition? Samples in proper containers/bottles? Sample containers intact? Sufficient sample volume for indicated test? Sample Receipt Information Yes ❑ No ❑ Yes d❑ No ❑ Yes W No ❑ Yes W No ❑ Yes 0 No ❑ Sample Preservation and Hold Time (HT1 Information All samples received within holding time? Yes d❑ No ❑ Container/Temp Blank temperature Cooler Temp: NA ❑� Water - VOA vials have zero headspace / no bubbles? Yes ❑ No ❑ No VOA vials submitted Sample labels checked for correct preservation? Yes d❑ No ❑ Metal - pH acceptable upon receipt (pH<2)? Yes ❑ No ❑ NA ❑d Samples Received on Ice? Yes ❑ Now * NOTE. If the "No"box is checked, see comments below. --------------------------------------------- - — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Comments: Page 6 of 16