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SGS Accutest Sample Receipt Summary <br /> Job Number: D84245 Client: ERC Project: SWAN <br /> Date I Time Received: 7/5/2016 8:55:00 AM Delivery Method: Airbill Vs: HD <br /> Cooler Temps(Initial/Adjusted): #1:(21/21): <br /> Cooler Security Y or N Y or N Sample Integrity-Documentation Y or N <br /> 1.Custody Seals Present. © ❑ 3.COC Present: © ❑ 1.Sample labels present on bottles: 0 ❑ <br /> 2 CustodySeals Intact: 0 ❑ 4.Smpl Datesrrime OK fJ ❑ ❑ <br /> 2.Container labeling complete: ® � <br /> Cooler Temperature Y or N 3.Sample container label/COC agree: © ❑ <br /> 1.Temp criteria achieved: 0 ❑ Sample 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: 1 <br /> - — 3.Condition of sample: Intact <br /> Quality Control Preservation Y or N N/A Sample Intearity-Instructions Y or N N/A <br /> 1.Trip Blank present/cooler: ❑ ❑ © 1.Analysis requested is clear: R ❑ <br /> 2.Trip Blank listed on CDC: ❑ ❑ 0 2.Bottles received for unspecified tests ❑ ❑/i <br /> 3.Samples preserved properly: R ❑ 3.Sufficient volume recvd for analysis: ® ❑ <br /> 4.VOCs headspace free: Cl ❑ Ej 4.Compositing instructions clear: ❑ ❑ ❑/ <br /> 5.Filtering instructions clear: ❑ ❑ V <br /> Comments <br /> D84245: Chain of Custody <br /> Page 2 of 2 <br /> of 27 <br /> SGS ACCUTEST <br /> D84245 <br />