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BC LABONATORIES li SAMPLE RECEIPT FORM Rev.No.10 01/21104 Page_Of _ <br /> Submission fl: 050 Project Code: TB Batch fi <br /> SHIPPING INFORMATION IPPING CONTAINER <br /> Federal Express ❑ UPS ❑ Hand Delivery ❑ Ice Chest None ❑ <br /> SC Lab Field Service 01 Other❑ (Specify) Box ❑ other ❑ (Specify) <br /> Refrigerant Ice flue Ice ❑ None ❑ Other❑ Comments: <br /> Custody Seals Ice Chest ❑ Containers ❑ None ❑ Continents: <br /> 1 <br /> All samples received? Yes No❑ AY samples containers intact? yes No❑ Description(a)match COC? Ysz No ❑ <br /> (`OC Received Ice Chest ID 1�kA Emissivity _ FDatefnme I)q`1-/CES ❑ NO Temperature: C Contairterf'1 Y Th ID: st Trot �- <br /> SAMPLE CONTAINERS 1 2 3 4 5 6 1 a 9 10 <br /> OT GFJ4E AL MINERALI GENERAL PHYSICAL <br /> IT PE UNPRFSERVED <br /> QT W0RGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> Pr CYANIDE <br /> Pr NITROGEN FORMS <br /> rt TOTAL SULFIDE <br /> tor_NrrKATE 1 NrrRTTE <br /> t0i TOTAL ORGANIC CARBON <br /> QT TOx <br /> PT CHEMICAL OXYGEN DEMAND <br /> Pt PHENOLICS <br /> 40.1 VOA VIAL TRAVEL BLANK <br /> 40.1 VOA VIAL <br /> T EPA 4113-1,413, 41&1 <br /> Pr ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 4Om1 VOA VIAL-504 <br /> T EPA 508/60818080 <br /> T EPA Sl5.IB150 OR <br /> OT EPA525 Y <br /> TEPA525TRAVELBLANK <br /> lOOW EPA 541 I I <br /> 100m1 EPA 53..1 <br /> T EPA S4r <br /> T EPA 549 <br /> EPA 632 <br /> T EPA SOLSM <br /> T SHORT I <br /> T AMBER 2 <br /> 907-JAR P' <br /> 3202 JAR <br /> SOIL SLEEVE <br /> PCB VIAL <br /> PLASTIC BAG <br /> FERROUSIRON <br /> ENCORE <br /> Comments <br /> Sample Numbering Completed By: Daternme: <br /> �H:\DOCS\WP001tA8 DOCS\POflMS\SAMPEC2 Wml <br />