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• 1 wwwznergylab.com Helena, MT 877-472-0711 , Billings, MT 800-735-4489 • Casper, WY 888-235-0515 <br />- -/ w / / Sdree X831 Gillette, WY 866-686-7175 0 Rapid City, SD 886-672-1225 • College Station, Tx 888-690-2218 <br />Workorder Receipt Checklist <br />Cotter Corporation <br />Login completed by: Corinne Wagner <br />Reviewed by: BL2000\tedwards <br />Reviewed Date: 8/23/2010 <br />i 11111111111 n ? l l l l l 9 <br />610080658 <br />Date Received: 8/18/2010 <br />Received by: ckw <br />Carrier name: FedEx <br />Shipping container/cooler in good condition? Yes [ No El Not Present 1:1 <br />Custody seals intact on shipping container/cooler? Yes No F-I Not Present 0 <br />Custody seals intact on sample bottles? Yes E] No [] Not Present 0 <br />Chain of custody present? Yes F,71 No F-l <br />Chain of custody signed when relinquished and received? Yes P No F-l <br />Chain of custody agrees with sample labels? Yes F,71 No F? <br />Samples in proper container/bottle? Yes 0 No 7 <br />Sample containers intact? Yes Z No F-I <br />Sufficient sample volume for indicated test? Yes F,71 No 0 <br />All samples received within holding time? Yes F,? No ? <br />Container/Temp Blank temperature: 14°C <br />Water - VOA vials have zero headspace? Yes ? No ? No VOA vials submitted 0 <br />Water - pH acceptable upon receipt? Yes Z No ? Not Applicable ? <br />-------------------- <br />- <br />------------------------------------------------------ <br />Contact and Corrective Action Comments: --------------- --------------- ------ <br />-- <br />None <br />Page 22 of 25