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HOUSTON LABORATORY <br /> 8880 INTERCHANGE DRIVE <br /> ® HOUST013 TEXAS 77054 <br /> (7131660-0901 <br /> Sample Receipt Checklist <br /> Workorder <br /> 00090294 Received by Barrera, Nancy I <br /> Date and Time Received 9113100 10 00 00 AM Carrier name FedEx <br /> Temperature 4 <br /> Shipping container/cooler in good condition? Yes 0 No ❑ Not Present ❑ <br /> Custody seals intact on shippping containerlcooler? Yes ❑ No ❑ Not Present 0 <br /> Custody seals intact on sample bottles? Yes ❑ No ❑ Not Present Rj <br /> Chain of custody present? Yes 0 No ❑ <br /> Chain of custody signed when relinquished and received? Yes 0 No ❑ <br /> Cham of custody agrees with sample labels? Yes 0 No ❑ <br /> Samples in proper container/bottle? Yes Q No ❑ <br />' Sample containers Intact? Yes No ❑ <br /> Sufficient sample volume for Indicated test? Yes Q No ❑ <br /> All samples received within holding time? Yes No ❑ <br /> Container/Temp Blank temperature in compliance? Yesd❑ No ❑ <br /> Or-VOA vials have zero headspace? Yes � No ❑ Not Present ❑ <br /> Water-pH acceptable upon receipt? Yes No ❑ <br /> i <br /> I <br /> I <br /> i <br />