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ENERGYLABORATOR/ES, /NC. • 2393Sa/7 CreekNighway(82601J • P.O. Box 3258 • Casper WYB2602 <br />Toll FreeB88.235r75/5 • 3022350515 • Far307.234.>639 • casperC~energylab.com•wwwenergylab.com <br />•:. <br />Energy Laboratories Inc. <br />Sampee Receipt Checklist <br />Client Name Cotter Corporation Date antl Time Received: 4114/2005 10:00:00 <br />Work Order Number 005040583 Received by rl1 <br />Checklist completed by: ~~j~n L~"-~ L{ I i ~~ ~_` ~ Reviewed by <br />Signature ~~~ttt ~ Dale Initials Hale <br />Carrier name UPS <br />Shipping container/cooler in good condition? <br />Custody seals intact on shipping container/cooler? <br />Custody seals intact on sample bottles? <br />Chain of custody present? <br />Chain of custody signed when relinquished and received? <br />Chain of custody agrees with sample labels? <br />Samples in proper container/bottle? <br />Sample containers intact? <br />Sufficient sample volume for indicated test? <br />All samples received within holding time? <br />Container/Temp Blank temperature in compliance? <br />Water -VOA vials have zero headspace? <br />Water - pH acceptable upon receipt? <br />Yes 0 No ^ Not Present ^ <br />Yes ^ No ^ Not Present ^~ <br />Yes ^ No ^ Not Present <br />Yes ~ No ^ <br />Yes ~ No ^ <br />Yes © No ^ <br />~ Yes (] No ^ <br />Yes (] No ^ <br />Yes ^~ No ^ <br />Yes ^~ No ^ <br />Yes ~ No ^ N/A°C Ore <br />Yes ^ No ^ No VOA vials subm itted <br />Yes ^ No ^ Not Applicable ^~/ <br />- Checked by <br />Adjusted? <br />Any No and/or NA (not applicable) response must be tletailetl in the wmments section below. <br />Client contacted <br />Date contacted: <br />Person contacted <br />Contacted by: <br />Comments: <br />Regarding: <br />Corrective Action <br />