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www.a?ergylab.com <br />AetpycalFirsirea'Sloea tiQi <br />24711 Billings, W 860-735-4489 • Casper, WY 888-235-0515 <br />Rapid L6. SD 88B-612-1225 • College Station, YX 888-690-2218 <br />Workorder Receipt Checklist IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII <br />Cotter Corporation C10110785 <br />Login completed by: Halley Ackerman Date Received: 11/22/2010 <br />Reviewed by: BL2000\alynch Received by: ha <br />Reviewed Date: 12/8/2010 Carrier name: Fed Ex <br />Shipping container/cooler in good condition? Yes No E] Not Present 1:1 <br />Custody seals intact on shipping container/cooler? Yes No E] Not Present Q <br />Custody seals intact on sample bottles? Yes Ej No Not Present <br />Chain of custody present? Yes [7-f No <br />Chain of custody signed when relinquished and received? Yes [ f No E] <br />Chain of custody agrees with sample labels? Yes Q No El <br />Samples in proper container/bottle? Yes No Q <br />Sample containers intact? Yes No ? <br />Sufficient sample volume for indicated test? Yes No ? <br />All samples received within holding time? Yes No ? <br />Container/Temp Blank temperature: 3°C On Ice <br />Water - VOA vials have zero headspace? Yes ? No El No VOA vials submitted Q <br />Water- pH acceptable upon receipt? <br />-------------- Yes Q <br />---------------- No F-1 <br />-------------- Not Applicable E] <br />----------------------------- <br />---------------------------------------- <br />------------------------------------------------------ <br />Contact and Corrective Action Comments: ---------------- -------------- ----------------------------- <br />None <br />Page 4 of 6 <br />