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BC UtaORATOBIES INC_ SAMPLE RECEIPT FORM Rev.No. 10 07/21104 Page Of !_ <br /> :; 'i L' Project Code: TB Batch # <br /> Submission !J: L' T �- � '� - 1 <br /> SHIPPING INFORMATION SHAPING CONTAINER <br /> Federal Express ❑ UPS_❑ Hand Delivery ❑ Ice Chest p' None ❑ <br /> b Field Service Q-"� Other❑ (Specify) Box ❑ Other ❑ (Specify) <br /> Refrigerant: Ice Blue Ice ❑ None ❑ Other ❑ Comments: <br /> Custody Seals Ice Chest ❑ Containers ❑ None ❑ Comments: <br /> ntact,Y� n so D <br /> A0 samples received? Yes No❑ AB samples containers intact? YesAl No❑ Description(s)match COC? Yas'C] No ❑ <br /> COC Received Ice chest ID Emissivity — -. j� Date?rime i <br /> Temperature: _'C Container <br /> Q,VE.S ❑ NO Thermometer ID: ik <br /> Analyst Inil <br /> SAMPLE CONTAINERS 1 2 3 4 5 6 7 B 9 10 <br /> OT GENERAL MINERAL/GENERAL PHYSICAL <br /> PT PE UNPRFSERVED <br /> Orr INORGANIC CHEMICAL METALS <br /> PI'iNodGANICCLD m1CAL METALS <br /> Pr CYANIDE <br /> PT N[7ROGEN FORMS <br /> Pr TOTAL SULFIDE <br /> 2ez NTTRAIE/NITRITE <br /> 10001 TOTAL ORGANIC CARBON <br /> TOX <br /> Pr CHEMICAL OXYGEN DEMAND <br /> PCA PHENOLICS <br /> � OA VIAL TRAVEL BLANK <br /> OA VIAL <br /> T EPA 413-1,413-2,41&1 <br /> Pr ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 W VOA VIAL 504 <br /> T EPA 50W60018080 <br /> EPA 515.118150 <br /> EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> lo0ral EPA 547 <br /> LOOM EPA 531-1 <br /> T EPA 548 <br /> T EPA 549 .._. __._.. <br /> T EPA 632 <br /> T EPA 80 LSM <br /> T <br /> T AMBER _ <br /> 8 OZ JAR g <br /> 32 O2 JAR O OIz ESOC1 P1iBA8 COT <br /> SOIL SLEEVE <br /> PCB VIAL <br /> PLASTIC BAG <br /> F USIRON <br /> EN RE <br /> ample <br /> Numbering <br /> r <br /> umbering Completeo By: t Date/Time: <br /> IN-uOfSIWP80\lA8 IH1C5\r0aM6\6AMPECI WrDI <br />