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DocuSign Envelope ID: D07924E6-3D94-4398-AO66-B683COBAB33E <br /> SAMPLE RECEIPT/CHAIN-OF-CUSTODY CHECKLIST <br /> The following items were checked for completeness, correctness,and compliance to project <br /> specifications using the Chain-of-Custody(COC)and othe fs�ipporting information. <br /> Date of acceptance: By: Y <br /> SVL Work No: V I� <br /> Item Description V NA Comments <br /> 1 Client or project name a_b�- � <br /> 2 Date and time of receipt at lab `V a Lf <br /> S� <br /> 3 Received by `f <br /> 4 Temperature blank r cooler temperature Temp.rlOC <br /> 5 Were the sample(s)received on ice <br /> 6 Custody tape/bottle seals <br /> 7 Shipper's air bill <br /> 8 Condition of samples upon receipt f <br /> (leaking;bubbles in VOA vials) <br /> 9 Analysis requested for each sample �- <br /> 10 Sample matrix description ` <br /> 11 The correct preservative for the analysis <br /> requested <br /> 12 Did an SVL employee preserve sample(s) <br /> upon receipt <br /> 13 Additional Information <br /> V-Verified NA-Not Applicable <br /> Comments. <br />