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� f <br /> i H LABORATORY <br /> 88800IN7E INTERCHANCsE DRIVE <br /> HOUSTCN,TX 77054 <br /> (713)66C-0901 <br /> Sample Receipt Checklist <br />` Workorder 01120303 Received By DS j <br /> Date and Time Received 1217101 10 00 00 AM Canner name FedEx <br /> i � I <br /> 1 Temperature 2 — - - Chilled by Water Ice <br /> 1 Shipping container/cooler in good condition? Yes 0 No ❑ Not Present ❑ <br /> r <br /> 2. Custody seals intact on shipppmg container/cooler? Yes ❑ No❑ Not Present ❑✓ <br /> Ii 3 Custody seals intact on sample bottles? Yes ❑ No ❑ Not Present <br /> C <br /> 4. Chain of custody present? Yes No❑ <br /> I r c <br /> I � 5 Chain of custody signed when relinquished and received? Yes No❑ <br /> 6. Chain of custody agrees with sample labels? Yes No❑ <br /> I C <br /> 7 Samples in proper contamerlbottle? Yes No ❑ <br /> 18. <br /> Sample containers lntactl Yes No❑ <br /> 9. Sufficient sample volume for indicated test? Yes No❑ <br /> 10 All samples received within holding time Yes ❑ No ❑ <br /> 11. Container[Temp Blank temperature in compliance? YesY❑ No ❑ <br /> 12 Water-VOA vials have zero headspace? Yes No❑ Not Applicable ❑ <br /> r <br /> 13 Water-pH acceptable upon receipt? Yes No ❑ Not Applicable ❑ <br /> SPL Representative i Contact Date&Time <br /> �w <br /> K Client Name Contacted � <br /> s ` <br /> Han Conformance <br /> 7 <br /> Issues <br /> A Client Instructions <br /> r` <br /> I' <br /> }2119101 3 48 21 PM <br />