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SAMPLE RECEIPT FORM <br /> Rev.Nc. 10 01121104 Page — Of _ <br /> BC LABORATORIES INC. TB Batch # <br /> (� <br /> SubmissiProject Code:on #: _ v SHIPPING CONTAINER <br /> SHIPPING INFORMATION Ice Chest p� None ❑ <br /> S ❑ Hand Delivery ❑ Box ❑ Other 11 (Specify) <br /> Federal Express ❑ Other ❑ (Specify) <br /> B Lab Field Service <br /> Refrigerant: Ice Blue Ice ❑ None ❑ Other ❑ Comments: <br /> Containers ❑ None L� Comments: <br /> Custody Seals: Ice Chest ID Containers <br /> vas [3 No ❑ <br /> Intact. Yes CI No ❑ <br /> -/ Descriptionlsl match CDC? Yes No ❑ <br /> / les containers intact? Yes 1w f3 No❑ .� <br /> All samples received? Yes l3" No 13 All sam p DatelTime <br /> Ice Chest ID Emissivity �i' <br /> OC Received Temprature: C Container Analyst Init nl ll <br /> e <br /> YES ❑ NO TI r er ID <br /> 6 <br /> SAMPLE CONTAINERS t 2 3 <br /> OT GENERAL MINERAL/GENERAL PHYSICAL n <br /> PT PE UNPRESERVED <br /> T INORGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 2=NITRATE/NITRITE <br /> Joe,]TOTAL ORGANIC CARBON <br /> T TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> PIA PHENOLICS <br /> q 'OA VIAL TRAVEL BLANK <br /> 4 A VIAL <br /> T EPA D3.1 413.2 418.1 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 ml VOA VIAL-504 <br /> T EPA 508/608/8080 <br /> T EPA 515.1/8150 <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> 100ml EPA 547 <br /> 100m1 EPA 531.1 <br /> T EPA 548 <br /> T EPA 549 <br /> T EPA 632 <br /> T EPA 8015M <br /> T A/ C <br /> T AMBER <br /> 8 OZ.JAR <br /> 32 OZ.JAR <br /> SOIL SLEEVE <br /> PCB VIAL <br /> PLASTIC BAG <br /> F S IRON <br /> EN E <br /> /TimjD <br /> Datee: <br /> Semple Numbering Completed By: U6 :1,0cs\WPBWLAe <br /> Comments: _oocs�FonMsISAMREcz.w <br />