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HOUSTON LABORATORY <br /> 8880 INTERCHANGE DRIVE <br /> HOUSTON TEXAS 77054 <br /> ® (713)660-0901 <br /> ' Sample Receipt Checklist <br /> I <br /> Workorder 00040550 Received by Stelly D'Anna <br /> Date and Time Received 4120100 10 00 00 AM Camer name FedEx <br /> I <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 ❑J <br /> Custody seals intact on sample bottles? Yes ❑ No❑ Not Present n <br /> Chain of custody present? Yes �] No❑ <br /> ' Chain of custody signed when relinquished and received? Yes ✓❑ No❑ <br /> Chain of custody agrees with sample labels? Yes ILI] 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 /> Container/Temp Blank temperature in compliance? Yes �� No <br /> Water-VOA vials have zero headspace? Yes No Not Present I <br /> Water-pH acceptable upon receipt? Yes (] No <br /> 1 <br />