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Project: <br />Accutest Job Number: D28612 <br />Date / Time Received: 10/14/2011 <br />Cooler Security <br />1 Custody Seals Present <br />2 Custody Seals Intact <br />Cooler Tern oerature <br />1 Temp cntena achieved <br />2 Cooler temp verification <br />3 Cooler media <br />Comments <br />Pscutest L.ahoratores <br />V(303) 425-0021 <br />Y or N <br />Y or N <br />® ❑ <br />Infared gun <br />Ice (bag) <br />Client: <br />❑ 3 COC Present <br />❑ 4 Smpl Dates/rime OK <br />Quality Control Preservation Y or N NIA <br />1 Tnp Blank present /cooler <br />2 Tnp Blank fisted on COC <br />3 Samples preserved properly <br />4 VOCs headspace free <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />Accutest Laboratories Sample Receipt Summary <br />No. Coolers: <br />Y <br />or N <br />Gil <br />4036 YongfeN Street <br />F (303) 425-6954 <br />Alrbill Vs: <br />Sample Integrity - Documentation <br />1 Sample labels present on bottles <br />2 Container labeling complete - <br />3 Sample container label / COC agree <br />Sample Integrity - Condition <br />1 Sample recvd within FIT <br />2 All containers accounted for <br />3 Condition of sample <br />Sample hteority - instructions <br />1 Analysis requested is clear <br />2 Bottles received for unspecified tests <br />3 Sufficient volume rec'd for analysts <br />4 Composihng instructions clear <br />5 Fddnng instructions clear <br />Immediate Client Services Action Required: No <br />Client Service Action Required at Login: No <br />l)?X612: <br />Y or N <br />® ❑ <br />O ❑ <br />Y or N <br />® ❑ <br />❑ <br />Intact <br />Y or N N/A <br />® ❑ <br />❑ <br />❑ ❑ <br />❑ ❑ <br />Wheat Ridge, CO <br />www/eccutest com <br />323_. t <br />12 of 17 <br />