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.r. <br />,'Energy Laboratories Inc. <br />Sample Receipt Checklist <br />Client Name Cotter Corporation <br />Work Order Number 005040583 <br />Date and Time Received: 4114/2005 10:00:00 <br />Receivetl by dt <br />Checklist completed by: L~j~ -~" L ~--t I j ~~~_~ Reviewed by <br />SipnaW're ~~~~~~ffffff ~~J~~J Da1a rniUele Dala <br />Carrier name <br />Shipping container/cooler in good condition? <br />Custody seals Intact on shipping container/cooler? <br />Custody seals intaG on sample bottles? <br />Chain o(cuslody present? <br />Chain of custody signed when relinquished and received? <br />Chain of custody agrees wiN sample fabelsl <br />Samples in proper container bottle? <br />Sample containers intaG? <br />L Sufficient sample volume (or indicated test? <br />~.~YII samples received within holding time? <br />Container/Temp 81ank temperature in compliance? <br />Water -VOA vials have zero headspacel <br />Water - pH acceptable upon receipt? <br />Adjusted? <br />Yes 0 No ^ Not Present ^ <br />Yes ^ No ^ Not Present <br />Yes ^ No ^ Nol Present <br />Yes 0 No ^ <br />Yes ~ No ^ <br />Yes Q tJo ^ <br />~ Yes 0 No ^ <br />Yes ® No ^ <br />Yes © No ^ <br />Yes 0 No ^ <br />Yes 0 No ^ WA •C Ore <br />Yes ^ No ^ No VOA vials submitted <br />Yes ^ NO ^ Not Applicable <br />- Checked try <br />Any No and/or NA (not applicable) response must be detailed in the canments sepion below. <br />Client contacted <br />Contactetl by: <br />Comments: <br />Regarding: <br />Person contacted <br />.l ~ <br />ENERGYLA80RATOn,cS, /NC. •7393Sa//CreekNighway/B26p1// • P.O &,.. J25B • Casper, WYB2607 <br />Tod Free BBB.2350515 • 307.23505f5 • Far 307.234.1639 • caspeiC>energy/ab.com • wwwenergy/ab.ct7m <br />Date contaced: <br />Corrective AGion <br />