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HOUSTON LABORATORY <br /> HANGS DRIVE 8880 INTERCHANGE DRIVE <br /> J HOUSTON TX 77054 <br /> (713)660-0901 <br />' Sample Receipt Checklist — — <br /> Workorder 01110955 Received By NS <br /> Date and Time Received 11/27/01 10 00 00 AM Carrier name FedEx <br /> Temperature 4 Chilled by Water Ice <br /> Shipping containerlcooler in good condition? Yes i' NoNot Present ` <br />' 2 Custody seals intact on shippping container/cooler? Yes No ❑ Not Present <br /> 3 Custody seals intact on sample bottles? Yes No Not Present <br /> 4. Chain of custody present? Yes No L'- <br /> 5 5. <br /> Chain of custody signed when relinquished and received? Yes n No❑ <br /> 6. Chain of custody agrees with sample labels? Yes 21 No ❑ <br /> 7 Samples in proper containerlbottle? Yes D No <br /> 10 Sample containers intact? Yes Rl No ❑ <br /> 9. Sufficient sample volume for indicated test? Yes 21 No10 ❑' <br /> All samples received within holding time? Yes 'Ell No u <br /> 11. Container/Temp Blank temperature in compliance? Yes D No❑ <br /> 12 Water-VOA vials have zero headspace? Yes No ❑ Not Applicable <br />' 13. Water-pH acceptable upon receipt? Yes 1/1 No ❑ Not Applicable ❑ <br /> SPL Representative Contact Date&Time <br />' Client Name Contacted — -- <br /> Non Conformance <br /> Issues <br /> tClient Instructions <br /> 12119/01 9 04 59 AM <br />