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I <br /> HOUSTON LABOCHANGE ATORY <br /> DRJVE <br /> 8e90 INTERCHANGE aRNE <br /> WW4 'MWO O HOUSTON TEXAS 77054 <br /> A <br /> (T13)650.0801 <br />' Sample Receipt Checklist <br />' Workorder 01010028 Received by Estrada Ruben <br /> Date and Time Received 1!3101 10 00 00 AM Carrier name FedEx <br />' Temperature 4 <br /> Shipping containertcooler In good condition? Yes No ❑ Not Present ❑ <br />' Custody seats intact on shippping containeNcooleO Yes ❑ No ❑ Not Present W <br /> Custody seals intact on sample bottles? Yes ❑ No ❑ Not Present ❑d <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 ❑ No <br /> Samples in proper container/bottle? Yes No ❑ <br /> Sample containers Intact? Yes d❑ No ❑ <br />' Sufficient sample volume for indicated test? Yes No ❑ <br /> All samples received within holding time? Yes ❑ No ❑ <br /> Fontainer/Tem p Blank temperature in compliance? Yes No ❑ <br /> Water-VOA vials have zero headspace? Yes ❑ No ❑ Not Present Q <br />' Water-pH acceptable upon receipt? Yes ❑ No R <br /> I <br /> I <br /> 1 <br /> 1 <br />' 1!15101 2 18 06?M <br />