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HOUSTON LABORATORY <br /> 8880 INTERCHANGE DRIVE <br /> HOUSTON,TX 77054 - <br /> ' (713)660-0901 <br /> Sample Receipt Checklist <br /> Workorder: 04061001 - Received By: NB <br /> Date and Time Received: 6125104 9:30:00 AM Carrier name: FedEx <br /> ' Temperature: 3.01C Chilled by: Water Ice <br /> 1. Shipping containerlcooler in good condition? Ye No❑ Not Present ❑ <br /> 2. Custody seals intact on shippping container/cooler? Ye ❑ No❑ Not Present <br /> ' 3. Custody seals intact on sample bottles? Ye ❑ No❑ Not Present 0 <br /> 4. Chain of custody present? Ye No❑ <br /> ' 5. Chain of custody signed when relinquished and receiv Ye Fel No❑ <br /> ' 6- Chain of custody agrees with sample labels? Ye 21 No❑ <br /> 7- Samples in proper container/bottle? Ye No❑ <br /> ' 8. Sample containers Intact? Ye No❑ <br /> ' 9. Sufficient sample volume for indicated test? Ye 0 No❑ <br /> �. All samples received within holding time? Ye No❑ <br /> ContainerlTemp Blank temperature in compliance? Ye 0 No❑ <br /> 12. Water-VOA vials have zero headspace Ye ❑ No❑ Not Applicable <br /> 13. Water-pH acceptable upon receipt? Ye ❑ No❑ Not Applicable 0 <br /> 1 <br /> SPL Representative: Contact Date&Time: <br /> Client Name Contacted: <br /> Non Conformance <br /> ' Issues: <br /> Client Instructions: <br /> 1 <br /> 1 <br /> 04061001 Page 54 <br /> TMM"7;17 PM <br />