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Laboratories Inc. Jik�_ <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1628545 Page 4 of 4 <br /> BC LABORATORIES INC. COOLER RECEIPT FORM Page ( Of <br /> Submission #: `Q•Z S 5 <br /> SHIPPING INFORMATION SHIPPING CONTAINER FREE LIQUID <br /> FBb <br /> UPS❑ Ontrac❑ Hand Delivery ❑ Ice Chest None ❑ Box ❑ YE NO ❑ <br /> ld Service Other❑(Specify) Other ❑(Specify) W f S <br /> Refrigerant: Icell Blue Ice❑ None❑ Other❑ Comments: <br /> Custody Seals Ice.>Chest�' Contalriers❑ None Comments: <br /> lrrttico-YLs.'n�No T1.1 <br /> All samples received? Yes No❑ All samples containers intact? Yes No❑ Description(s)match COC? Yes No ❑ <br /> COC Received Emissivity: Q_y�Container:� Thermometer ID:_� Datell'ime It <br /> DYES ElNO Temperature: (A) 0' 1 °C / (C } D. C Analyst Init a <br /> ° <br /> SAMPLE NUMBERS <br /> SAMPLE CONTAINERS 1-7 <br /> j 8 P <br /> T PE UNPRES 01- 4qi� <br /> 4oz/Soz/16oz PEUNPRES <br /> 2oz Cr*' <br /> T INORGANIC CHEMICAL METALS <br /> INORGANIC CHEMICAL METALS 4oz/Soz/16oz <br /> PT CYANIDE /• <br /> PT NITROGEN FORMS C G- <br /> PT TOTAL SULFIDE <br /> 2oz.NITRATE/NITRITE <br /> PT TOTAL ORGANIC CARBON <br /> PT CHEMICAL OXYGEN DEMAND <br /> PtA PHENOLICS <br /> 40ml VOA VIAL TRAVEL BLANK <br /> 40.1 VOA VIAL ' <br /> T EPA 1664 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 m1 VOA VIAL-504 <br /> T EPA 5081608/8080 <br /> T EPA 515.118150 <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> 40ml EPA 547 <br /> 40mi EPA 531.1 <br /> Soz EPA 548 <br /> T EPA 549 <br /> T EPA 8015M <br /> T EPA 8270 <br /> Boz/16oz/32oz AMBER <br /> R <br /> 32oz JAREVEBAGAG IRONIT <br /> SUMMA CANISTER <br /> Comments <br /> Sample Numbering Completed By: [late/Time: Rev 21 05/2312016 <br /> 4 — <br /> A'1-1 t r — 1---a i IcnW°n,..IW�.aV..l...11pn llfr..C1FARMSIt4MRFr...°J�l <br /> The results in this report apply to the samples analyzed in accordance with the chain of custody document.This analytical report must be reproduced in its entirety. <br /> All results listed in this report are for the exclusive use of the submitting party. BC Laboratories,Inc.assumes no responsibility for report alteration,separation,detachment or third party interpretation. <br /> Report ID: 1000538621 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.bclabs.com Page 7 of 59 <br />