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HOUSTON LABORATORY <br /> 8990 INTERCHANGE DRIVE <br /> 00 <br /> 60HOUSTON TEXAS 77054 <br /> ,TMO ® (713)660-0901 <br /> Sample Receipt Checklist <br /> Workorder 00080031 Received by Stelly,D'Anna <br /> Date and Time Received 817100 10 00 00 AM Carrier name FedRx <br /> Temperature 4 <br /> Shipping container/cooler In good condition? Yes No❑ Not Present ❑ <br /> Custody seals intact on shippping container/cooler? Yes ❑ No❑ Not Present <br /> Custody seals intact on sample bottles? Yes ❑ No❑ Not Present <br /> Chain of custody present? Yes 0 No❑ <br /> Chain of custody signed when relinquished and received? Yes ❑ No❑ <br /> Chain of custody agrees with sample labels? Yes ❑� No❑ <br /> Samples In proper contamer/bottle? Yes ❑� No❑ <br /> Sample containers intact? Yes 0 No❑ <br /> Sufficient sample volume for indicated test? Yes No❑ <br /> All samples received within holding time? Yes No❑ <br /> Container/Temp Blank temperature in compliance? Yes Q No❑ <br /> Water-VOA vials have zero headspace? Yes Q No❑ Not Present ❑ <br /> Water-pH acceptable upon receipt? Yes ❑�/ No❑ <br />