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BC L,4'BORA;iflRIES INC SAMPLE RECEIPT FORM Rev No 10 011121t0 Page Of <br /> Submission #'05- CP 37.3 Protect Code TB Batch # <br /> SHIPPING INFORMATIONS PING CONTAINER <br /> Fal Express L❑ S ❑ Hand Delivery ❑ Ice Chest None ❑ <br /> b Field Service Other ❑ (Specify} Box CI Other D (Specify) <br /> Refrigerant ice Blue Ice ❑ None ❑ Other ❑ Comments <br /> Custody Seals Ice Chest ❑ Containers ❑ None Comments <br /> lintacV' Yes DNp ❑ Intact7 Yes ❑ No / <br /> All samples recelved7 Yes No 0 All samples containers Intact? Yes No 0 Descriptionts) match COC7 Yes- No ❑ <br /> gC Received Ice Chest ID Uk) Emissivity R5 Date/Tim.v &c6pa1 <br /> Temperature l—a °G Container U6A U <br /> YES ❑ NO IThermometer ID Analyst Inst <br /> SAMPLE CONTAINERS h 12 13 15 s 17 a 9 t0 <br /> QT GENERAL MINERAL/GENERAL PHYSICAL <br /> PT PE UNPRESERVED <br /> T ENORGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> i <br /> 2oz NITRATE 1 NITRITE <br /> 100mt TOTAL,ORGANIC CARBON <br /> T TOX <br /> PT CHEMICAL OXYGEN DEAIAND <br /> Pt NOLICS <br /> AIWA VIAL TRAVEL BLANK <br /> 40ml VOA VIAL , j I I <br /> 3EPA 4131 4132 3161 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 ml VOA VIAL 504 <br /> T EPA 5081608!8080 <br /> T EPA 515 118150 <br /> T EPA 5I5 <br /> T EPA 525 TRAVEL BLANK <br /> t00ml EPA 547 <br /> [00ml EPA 531 1 <br /> T EPA 548 <br /> T EPA 549 <br /> T EPA 632 <br /> T EPA 801 SM <br /> T QAIQC <br /> T AMBER <br /> i OZ JAR <br /> �2 OZ JAR <br /> POILSI Fr VF <br /> 'CB VIAL <br /> BAG <br /> .E S IRON <br /> NCORE <br /> )mments <br /> imple Numbercng Completed 9y DatelTtme `J 31 S <br /> {H lO0051WP8WtAe_nOCSiFfl AMS1SAMRf C2 WP[ I <br />