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BC LQBORXi ORIES INC SAMPLE RECEIPT FORM Rev No to 01/21104 Page _ Of <br /> c� <br /> Submission # C)S— 1D 3?3 Project Code TB Batch # <br /> SHIPPING INFORMATION S PING CONTAINER <br /> F rat Express O S ❑ Hand Delivery ❑ Ice Chest None ❑ <br /> Ib Field Service � Other ❑ {Specify) Box ❑ Other ❑ (Specify) <br /> Refrigerant Ice Blue Ice ❑ None ❑ Other ❑ Comments <br /> Custody Seats Ice Chest ❑ Containers ❑ None Comments <br /> lintac0' Yes ❑ tJ2 ❑ Intact, Yes ❑ No <br /> Ail samples received? Yes Ne ❑ All samples containers intact Yes No U Descriptronlsi match COC' Yes Pr/N`o�/❑ <br /> C Received Ice Chest 0 _�I1lj Emissivity q5 Date/Time(P I Cha.Pl <br /> {� YCb ❑ NO Temperature _•c Container V6A <br /> Thr ID Analyst Init---.qAMPIE NUMBERS <br /> U <br /> SAMPLE CONTAINERS t z 5 6 7 a 9 to <br /> QT GENERAL MINERAL/GENERAL PHYSICAL <br /> PT PE UNPRESERVED <br /> T INORGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 2oz NITRATE/NITRITE <br /> 100mi TOTAL ORGANIC CARBON <br /> T TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> PtAd11&WNQLICS <br /> 40MA VIAL TRAVEL BLANK <br /> 40ml VOA VIAL i i s Pr r i i r <br /> TEPA 4131 4132 4181 <br /> PT ODOR <br /> RADIOLOGICAL I <br /> BACTERIOLOGICAL <br /> 10 ml VOA VIAL-504 <br /> T EPA 508/608!8080 <br /> T EPA 515 IMISO <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> 00ml EPA 547 <br /> 00mt EPA 531 1 <br /> T EPA 548 <br /> T EPA 549 CHK EW DI 3TF <br /> T EPA 632 <br /> T EPA 8015M <br /> T QA/0C —�- <br /> ��U 0 <br /> T AMBER <br /> OZ JAR7- <br /> 2 OZ JAR <br /> OIL Sl hl-Vi <br /> CB VIAE <br /> IF SIRON <br /> NCORE <br /> ,mMents <br /> mple Numbering Completed By Date/Time � 5 <br /> ;H SgOCSiWPBgtt AB OgCSiF ORM$ISMAEC2 WP[ <br />