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HOUSTON LABORATORY <br /> 8880 INTERCHANGE DRIVE <br /> HOUSTON,TEXAS 77054 <br /> Q (713)660-0801 <br /> Sample Receipt Checklist <br /> Workorder 00050532 Received by Stelly,UAnna <br /> Date and Time Received 5118/00 10 00 00 AM Carver name FedEx <br />' Temperature 4 <br /> Shipping container/cooler in good condition? Yes © No❑ Not Present ❑ <br /> Custody seals Intact on shippping container/cooler? Yes ❑ No❑ Not Present d❑ <br /> Custody seals Intact on sample bottles? Yes ❑ No LJ Not Present Nd <br /> Chain of custody present? Yes No I—` <br /> Chain of custody signed when relinquished and received? Yes © No L1 <br /> Chain of custody agrees with sample labels? Yes No <br /> Samples in proper containerlbottle? Yes CJ No I A <br /> Sample containers Intact? Yes n No <br /> Sufficient sample volume for indicated test? Yes 0 No <br /> All samples received within holding time? Yes No <br /> i Container/Temp Blank temperature in compliance? Yes ISI No I <br /> Water-VOA vials have zero headspace? Yes Id! No Not Present <br /> Water-pH acceptable upon receipt? Yes ki�I No <br /> r <br /> f <br /> t <br />