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BC LABORATORIES INC. /� SAMPLE RECEIPT FORM Rev. No. 10 01/21104 Page _ Of <br /> Submission H: — v Project Code: TB Batch At <br /> SHIPPING INFORMATION IPPING CONTAINER <br /> Federal Express ❑ �PS ❑ Hand Delivery El Ice Chest p� None 1-1B Lab Field Service Other ❑ (Specify) Box ❑ Other ❑ (Specify) <br /> rAlisample:s <br /> get: Ice Blue Ice ❑ None ❑ Other ❑ Comments: <br /> dyeals: Ice Chest ❑ Containers ❑ None � Comments: <br /> Intact?Ves ❑/No ❑ Intact? Yes ❑ No ❑ E/ <br /> / <br /> received? Yes Or No ❑ All samples containers intact? Yes E No ❑ Description(s) match COC? Yes tJ No ❑ <br /> AS <br /> Received Ice Chest ID '� Emissivity Ci Date/Time <br /> ` '� <br /> 13 YES ❑ NOTemperature: C Container <br /> Analyst (nit <br /> Thermometer ID, <br /> SA ill RFRq <br /> SAMPLE CONTAINERS t 2 3 4 <br /> OT GENERAL MINERAL/GENERAL PHYSICAL PIN <br /> /y <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 /> 2oz NITRATE/NITRITE <br /> 100.1 TOTAL ORGANIC CARBON <br /> T TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> PIA PHENOLICS <br /> 4 ' .4 VIAL TRAVEL BLANK <br /> 4 <br /> T EPA 413.1 413.2 418.1 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 ml VOA VIAL-504 <br /> T EPA 508/608/8080 <br /> QT EPA 515.1/8150 <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> 100m1 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 QA/OC <br /> OTAMBER <br /> 8 OZ.JAR <br /> 32 OZ.JAR <br /> SOILSLEEVE <br /> PCB VIAL <br /> PLASTIC BAG <br /> F( JS IRON <br /> EN E <br /> Comments, <br /> Sample Numbering Completed By: Date!Time, /'16 01a ^ <br /> (J D0CS1WP801LP6_DOCS\FORMS\SRMRE C2 WPDI <br />