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SGS Accutest Sample Receipt Summary <br /> Job Number: D82029 Client: CEMEX Project: <br /> Date/Time Received: 4/23/2016 9:35:00 AM Delivery Method: Airbill Ws: FX <br /> Cooler Temps(Initial/Adjusted): #1:(20.2/20.21^ <br /> Cooler Security Y or N Y or N Sample Integrity-Documentation Y or N <br /> 1.Custody Seals Present: ® ❑ 3.COC Present: ® C 1.Sample labels present on bottles: R ❑ <br /> 2.Custody Seals Intact: ® ❑ 4.Smpl Dates/Time OK ® 2.Container labeling complete: R ❑ <br /> Cooler Temperature Y or N 3.Sample container label/COC agree: ® ❑ <br /> 1.Temp criteria achieved: ® ❑ Samole Integrity-Condition Y or N <br /> 2.Cooler temp verification: IR Gun; El1.Sample recvd within HT: <br /> 3.Cooler media: Ice(Bag) <br /> 2.All containers accounted for: ® ❑ <br /> 4.No.Coolers: <br /> 3.Condition of sample: Intact <br /> Quality Control Preservation Y or N N/A Sample Integrity-Instructions Y or N N/A <br /> 1.Trip Blank present/cooler: ❑ ❑ <br /> 1.Analysis requested is clear: ® ❑ <br /> 2.Trip Blank listed on COC: ❑ ❑ ® 2.Bottles received for unspecified tests ❑ <br /> 3.Samples preserved properly: ® ❑ 3.Sufficient volume recvd for analysis: 0 ❑ <br /> 4.VOCs headspace free: ❑ ❑ © 4.Compositing instructions clear: ❑ ❑ 0 <br /> 5.Filtering instructions clear: ❑ ❑ <br /> Comments <br /> D82029: Chain of Custody <br /> Page 2 of 2 <br /> of 51 <br /> SGS ACCUTEST <br /> D82029 <br />