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SGS Accutest Sample Receipt Summary <br /> Job Number: D82159 Client: CEMEX Project: LYONS QUARRY TR 15 KILN BAGHOUSES DUST <br /> Date/Time Received: 4/29/2016 9 50 00 AM Delivery Method: Airbill#'s: fxe <br /> Cooler Temps(Initial/Adjusted): #1 (14 2/14 2). <br /> Cooler Security Yor N Y or N Sample Intearity-DocumentationY or N <br /> 1 Custody Seals Present © ❑ 3 COC Present 0 ❑ ❑ <br /> 1 Sample labels present on bottles 2 <br /> 2 Custody Seals Intact. © ❑ 4 Smpl Dates/Time OK © ❑ ❑ <br /> 2 Container labeling complete 0 <br /> 3 Sample container label/COC agree ❑ PI <br /> Cooler Temperature Y or N 8 p <br /> 1 Temp cnteria achieved 0 ❑ Sample Intearity-Condition Y or N <br /> 2 Cooler temp venfication IR Gun, El <br /> Sample recvd within HT. 0 <br /> 3 Cooler media Ice(Bag) <br /> 2 All containers accounted for. [2 ❑ <br /> 4 No Coolers 1 <br /> 3 Condition of sample Intact <br /> Quality Control Preservation Y or N N/A <br /> Sample Integrity-Instructions Y or N N/A <br /> 1 Trip Blank present/cooler ❑ ❑ ❑d 1 Analysis requested is clear © ❑ <br /> 2 Trip Blank listed on COC ❑ ❑ 0 2 Bottles received for unspecified tests ❑ <br /> 12 <br /> 3 Samples preserved properly © C 3 Sufficient volume recvd for analysis E] ❑ <br /> 4 VOCs headspace free ❑ ❑ © 4 Compositing instructions clear ❑ ❑ ❑i/ <br /> 5 Filtenng instructions clear ❑ ❑ WI <br /> Comments <br /> D82159: Chain of Custody <br /> Page 2 of 2 <br /> '13 of 46 <br /> SGS ACCUTEST <br /> 082159 <br />