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gc LAgOMTOwES INC. SAMPLE RECEIPT FORM Rev.No_ 10 01121/04 Page -L Of <br /> Project Code: TB Batch k <br /> Submission ti: 1 <br /> SHIPPING INFORMATION SNIPPING CONTAINER <br /> Federal Express ❑ PPS ❑ Hand Delivery ❑ Ice Chest 13 None ❑ <br /> BC Lab Field Service l4 Other❑ (Specify) flux ❑ Other ❑ ISpecifyl • <br /> Refrigerant: Ice Blue Ice ❑ None ❑ Other ❑ Comments: <br /> Custody Seals' Ice Chest ❑ Containers ❑ None ❑ Comments: <br /> AB samples received? Yes No❑ AI samples contamer intact? Yes No❑ Description(s)match COC? Yes❑ No ❑ <br /> COC Received Ice Chest ID Enlssivity r� Dateffime i ' <br /> ❑ YES ❑ NO Tentpenture: "C container b/C,CI <br /> T ID: -4 Analyst toil l� <br /> SAMPLE CONTAINERS 1 2 D 4 5 5 > b 5 <br /> OT GENERAL MINERAL/GENERAL PHYSICAL <br /> Pr PE IINPRESERVED <br /> INORGANIC CHEMICAL METALS <br /> Pr INORGANIC CHEMICAL METALS <br /> Pr CYANIDE <br /> Pr NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 12oz NrrkATE INITRITE <br /> 100m1 TOTAL ORGANIC CARBON <br /> T TO% <br /> Pf CHEMICAL,OXYGEN DEMAND <br /> PIA PID?NOLICS <br /> 40m1 VOA VIAL TRAVEL BLANK <br /> 40m1 VOA VIAL. <br /> T EPA 413-1,413.4418-1 <br /> PT ODOR <br /> RADIOLOG ICAI. <br /> BACTERIOLOGICAL <br /> 40M VOA VIAL- <br /> T EPA 508/6088080 <br /> T EPA 515-USISO <br /> QrT EPA 55 <br /> T EPA 575 TRA VEL BLANK <br /> Wood EPA 547 <br /> IOOad EPA 531-1 <br /> T EPA 5 I <br /> T EPA 549 <br /> T EPA 632 <br /> QT EPA 80 L5M <br /> T <br /> T AMBER <br /> 8OZ JAR <br /> 32 02 JAR <br /> SOIL SLEEVE <br /> PCB VIAL <br /> PLASTIC BAG . <br /> FERROUSIRON <br /> ENCORE <br /> omments: > <br /> ample Numbering Completed BY: ��-/ DateTme: <br /> IM'\00CS\WP80\l AB p0051FORM5\SAMBEC2 WFOI <br />