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LJTEST Accutest Laboratories Sample Receipt Summary <br />1.Re DH R1*0N1as <br />Accutest Job Number: C41950 Client: DYSERT <br />Date /Time Received: 9/24/2015 10:00:00 AM Delivery Method: Accutest Courier <br />Cooler Temps (InitiallAdjusted): #170,911-9)l <br />Cooler Security Y <br />1. Custody Seals Present: ❑ <br />or N Y or N <br />® 3. COC Present: ® ❑ <br />2. Custody Seals Intact: ❑ <br />❑ 4. Smpl Dates/Time OK ® ❑ <br />Cooler Temperature <br />1. Temp criteria achieved: <br />Y or N <br />® ❑ <br />2. Therm ID: <br />IRI; <br />3. Cooler media: <br />Ice (Bag) <br />4. No. Coolers: <br />1 <br />Quality Control Preservation <br />Y or N N/A <br />1. Trip Blank present / cooler: <br />❑ ® ❑ <br />2. Trip Blank listed on COC: <br />❑ ® ❑ <br />3. Samples preserved property: <br />® ❑ <br />4. VOCs headspace free: <br />® ❑ ❑ <br />Project: PACTIV PACKAGING <br />Airbill #'s: <br />A <br />Sample Intearity - Documentation Y or N <br />1. Sample labels present on bottles: ® ❑ <br />2. Container labeling complete: ® ❑ <br />3. Sample container label / COC agree: ® ❑ <br />Sample Integrity - Condition Y or N <br />1. Sample recvd within HT: ® ❑ <br />2. All containers accounted for: ® ❑ <br />3. Condition of sample: Intact <br />Sample Intearity -Instructions Y or N N/A <br />1. Analysis requested is clear: ® ❑ <br />2. Bottles received for unspecified tests ❑ <br />3. Sufficient volume recvd for analysis: ® ❑ <br />4. Compositing Instructions clear. ❑ ❑ <br />v:40BS88.0200 F: 408.588.0201 wwwlacculect.wn <br />C4195OW: Chain of Custody <br />Page 2 of 2 <br />SIR 9of14 <br />E ACCIJTE^aT. <br />C4195OW """""""" <br />