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k4l wwwenergylab.cflm Helena, MT 877-472-0711 • Billings, Mr 800-735-4489 • Casper, WY 888-235-0515 <br />An&"EwbEnc?Ak a fig Gillette, WY 866-686-7175 • Rapid City, S0 888-572-1225 • CoOele Station. TX 888-690-2218 <br />Workorder Receipt Checklist <br />Cotter Corporation <br />Login completed by: Corinne Wagner <br />Reviewed by: BL20001hackerman <br />Reviewed Date: 11/8/2010 <br />IYYIYYYYII?I <br />010101123 <br />Date Received: 10/29/2010 <br />Received by: em <br />Carrier name: FedEx <br />Shipping container/cooler in good condition? Yes No F! Not Present <br />Custody seals intact on shipping container/cooler? Yes No El Not Present Q <br />Custody seals intact on sample bottles? Yes El No ? Not Present <br />Chain of custody present? Yes [?( No <br />Chain of custody signed when relinquished and received? Yes Q No <br />Chain of custody agrees with sample labels? Yes No <br />Samples in proper container/bottle? Yes No <br />Sample containers intact? Yes No F-l <br />Sufficient sample volume for indicated test? Yes 0 No M <br />All samples received within holding time? Yes Q No F1 <br />Container/Temp Blank temperature: 5°C On Ice <br />Water - VOA vials have zero headspace? Yes No E] No VOA vials submitted Q <br />Water - pH acceptable upon receipt? Yes [?7f No F-I Not Applicable <br />Contact and Corrective Action Comments: <br />None <br />Page 28 of 37