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0 <br /> w CCIJTEST. Accutest Laboratories Sample Receipt Summary <br /> La 90PTTO R,68 <br /> Accutest Job Number: C27163 Client: KLEINFELOER-Irvine,CA Project: COSTCO-TRACY,CA <br /> Date/Time Received: 4/11/2013 Delivery Method: Accutest Courier Airbill#'s: <br /> Cooler Temps(Initial/Adjusted): #1:(3.6/3.6): 0 <br /> Cooler Security Y or N Y or N Sample Integrity-Documentation Y or N <br /> 1.Custody Seals Present: ❑ 2 3.COC Present: 2 ❑ 1.Sample labels present on bottles: 2 ❑ <br /> 2.Custody Seals Intact: ❑ ❑ 4.Smpl DatesTime OK 2 ❑ 2.Container labeling Complete: 2 ❑ N <br /> Cooler Temperature Y or N <br /> 3.Sample Container label/COC agree: 2 ❑ <br /> 1.Temp criteria achieved: 2 ❑ Sample lnlearily-Condition Y or N <br /> 2.Cooler lamp verification: IR Gun2 ❑ <br /> 1.Sample recvd within HT; <br /> 3.Cooler media: Ice(Bag) 2.All Containers acwunted for: 2 ❑ <br /> 4.No.Coolers: 1 3.Condition of sample: Intact <br /> Quality Control Preservation Y or N N/A Sample Intearity-Instructions Y or N N/A <br /> 1.Trip Blank present/water ❑ ❑ 2 1.Analysis requested is Gear: 2 ❑ <br /> 2.Trip Blank listed on COC: ❑ ❑ 2 2.Bottles received for unspecified tests ❑ 2 <br /> 3.Samples preserved properly: ❑ ❑ 3.Sufficient volume recvd for analysis: 2 ❑ <br /> 4.VOCs headspace free: ❑ ❑ 2 4.Compositing instructions Gear: ❑ ❑ 2 <br /> 6.Filtering instructions Gear: ❑ ❑ 2 <br /> Comments <br /> Ac,.vle9lzbaalorec 2105 Lundy Avenue Sen bu,CA 95131 <br /> VA08.5880200 F:408.5e0A301 wwMeCubM.wm <br /> C27163: Chain of Custody <br /> Page 2 of 2 <br /> EM 12 of 17 <br /> w ACCUTEST. <br /> C27163 ...... "•,•• <br />