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1 <br />' HOUST LABORATORY <br /> 8880 INTERCHANGE DRIVE <br /> HOUSTON TEXAS 77054 <br /> I� (713)660 0901 <br />' Sample Receipt Checklist <br />' Workorder 00120251 Received by Stelly, D Anna <br /> Date and Time Received 1217100 10 00 00 AM Carrier name FedEx <br />' Temperature 3T <br /> Shipping container/cooler in good condition? Yes No __ Not Present u <br /> Custody seals intact on shippping container/cooler? Yes _ No z Not Present �I <br /> Custody seals Intact on sampke bottles? Yes No Not Present Ldl <br /> Chain of custody present? Yes No <br />' Chain of custody signed when relinquished and received? Yes di No l– <br /> Chain of custody agrees with sample labe#s? 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 />' �ntainer/Temp Blank temperature in compliance? Yes 1; No — <br /> Water-VOA vials have zero headspace? Yes No Not Present ''3 <br /> Water-pH acceptable upon receipt? Yes No r <br /> I <br /> 1 <br /> 00120251 Page 22 <br />' 12/21100 10 o9 15 AM <br />