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I ._ ENERGY LABORATOR/ES, /NC. • 2393 SaII Creek Highway (82601) • P.O. Box 3258 • Casper, WY82602 <br />Tol/Free.8B823505Y5 • 3072350515 • Fax 307234.1639 ° casper@energylab.com • wwwenergylab.com <br />•~. . <br />I Energy Laboratories Inc. <br />Sample Receipt Checklist <br />Client Name Cotter Corporation Date and Time Received: 4/27/2005 09:00:00 <br />Work Crder Number 005041094 Received by rI1 <br />(1~ ` ` C <br />Checklist completed by:~ `\ `~1. ...\. \ ~~ _ ~Q , p5 Reviewed by <br />S'Ig~ul~eJ ~~77!!~~^ pale vv Initials Date <br />Carrier name Fed Ex <br />Shipping conlainerlcooler in gootl 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 />Adjusted? <br />Yes ~ No Not Present <br />Yes No Not Present y <br />Yes No Not Present ~ <br />Yes ~/ No <br />Yes ~/ No <br />Yes ~! No <br />Yes ~C No <br />Yes K No <br />Yes ~/ No <br />Yes J No <br />Yes Y No N!A°C Soil <br />Yes No No VOA vials submitted ~ <br />Yes No Not Applicable J <br /> Checked by <br />Any No and/or NA (not applicable) response must be detailed in the comments section below. <br />Client contacted Date contacted: Person contacted <br />Contacted by: Regarding: <br />Comments: <br />Corrective Action <br />T I-ar-kxt ~:n S~ainga Paae <br />r5 <br />