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BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev.No. 10 01/21/04 Page _Of <br /> Submission #: iJ <br /> - ofY� - Project Code: TB Batch # <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> UP - Hand Derwery ❑ Ice Chest IY" None ❑ <br /> Federal Field Ss ❑ Box ❑ Other ❑4Specify) <br /> Field Service Other❑ (Specify) <br /> Refrigerant Ice ❑ Bette Ice ❑ None ❑ - Other❑ Comments: <br /> Custody Sealsice Chest ❑ Containers ❑ None p-nomments: <br /> a ' <br /> AN saples received? Yes O' No ElR mrs Asaples comaineintact? Yes 1�No❑ Descriptionts)match COC? Yss�) No ❑ <br /> m � <br /> Ice Chest ID G ranissivity .cly DatefTime l� l —1G3 <br /> C Received Temperature: ^C Container <br /> ES C1 NO Th m ID: Analyst Ink N <br /> SAMPLE CONTAINERS 1 2 3 • s <br /> 6 1 a 9 10 <br /> OT GENERAL MINERAL/GENERAL PHYSICAL <br /> rT PE UNPRFSE:RVED <br /> INORGANIC CIWMICAL METALS <br /> Pr INORGANIC.CIlF.1dICAL METALS <br /> rr CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE _ <br /> 2az NITRATE/NITRITE <br /> weeii TOTAL ORGANIC CARBON <br /> T TOR <br /> PT CIRMICAL OXYGEN DEMAND <br /> M PHENOLICS <br /> OA VIAL TRAVEL BLANK <br /> OA VIAL <br /> EPA413.1 411. 018.1 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> N m VOA VIAL-504 <br /> T EPA 508/609=80 <br /> EPA SIS.IBI50 <br /> 1QT <br /> EPA M <br /> EPA 525 TMVEL BLANK <br /> t00m1 EPA 547 <br /> t00mt EPA 571.1 <br /> T EPA At <br /> T EPA 549 <br /> T EPA 6.12 <br /> UT EPA F15M <br /> T <br /> T AMBER <br /> 8 OZ JAR <br /> 1202 JAR <br /> SOIL SLEEVE <br /> PCB VIAL <br /> PLASTIC BAG <br /> US IRON <br /> EN RE <br /> :omments: U <br /> :amri <br /> :ample NOmbeng Completed BY: Date/Time: <br /> IH,D0131WMMLA0 DOCS\FOBMSISAMREC3 W <br /> MI <br /> l /3� <br />