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SGS Accutest Sample Receipt Summary <br /> Job Number: D80386 Client: CEMEX Project: LYONS <br /> Date/Time Received: 3/2/2016 2:45:00 PM Delivery Method: Airbill Vs: HD <br /> Cooler Temps(Initial/Adjusted): #1:(24.2/24.2): <br /> Cooler Security Y or N Y or N Samole Intearity-Documentation Y or N <br /> 1.Custody Seals Present: © ❑ 3.COC Present: ❑d ❑ 1.Sample labels present on bottles: W ❑ <br /> 2.Custody Seals Intact: © ❑ 4.Smpl Dates/rime OK © ❑ El2.Container labeling complete: <br /> (r] <br /> agree: <br /> 3.Sample container label/COC a El5A <br /> Cooler Temperature Y or N P 9 <br /> 1.Temp criteria achieved: 0 ❑ Sample Intearity-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: 1 <br /> 3.Condition of sample: Intact <br /> Quality Control Preservation Y or N NIA Sample Intearity-Instructions Y or N N/A <br /> 1.Trip Blank present/cooler: ❑ ❑ © 1.Analysis requested is clear: © ❑ <br /> 2.Trip Blank listed on COC: ❑ ❑ © 2.Bottles received for unspecified tests ❑ <br /> 3.Samples preserved properly: Q ❑ 3.Sufficient volume recvd for analysis: © ❑ <br /> 4.VOCs headspace free: ❑ ❑ © 4.Compositing instructions clear: ❑ ❑ <br /> 5.Filtering instructions clear: ❑ ❑ <br /> Comments <br /> D80386: Chain of Custody <br /> Page 2 of 2 <br /> SGS ACCUTEST <br /> D80386 <br />