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rLaIbFieldService <br /> ORIES INC. SAMPLE RECEIPT FORM Rev. No. 10 01121/04 Page _ Of <br /> n #: —� Project Code: TB Batch # <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> ess ❑ UPS ❑ Hand Delivery ❑ Ice Chest None ❑ <br /> Service Other ❑ (SpecitylBox ❑ Other ❑ (Specify) <br /> : Ice f� Blue Ice ❑ None ❑ Other ❑ Comments: <br /> als: Ice Chest ❑ Containers ❑ None 0( Comments: <br /> Intact? Yes ❑No ❑ Intact?Yes ❑ No ❑ / <br /> All samples received? Yes 2/ No ❑ All samples containers intact? Yes Cor No ❑ Description(s) match COC? Yes Pf No ❑ <br /> OC Received Ice Chest to Emissivity c�a,v Date/Time <br /> YES El NO Temperature: °C Container Analyst Init �io <br /> Thr er lD' <br /> SAMPLE CONTAINERS t 2 <br /> QT GENERAL MINERAL/GENERAL PHYSICAL <br /> PT PE UNPRESERVED <br /> T INORGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFI DE <br /> 20L NITRATE/NITRITE <br /> 100m1 TOTAL ORGANIC CARBON <br /> T TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> PIA PHENOLICS <br /> 40 A VIALTRAVELBLANK <br /> 40 A VIAL <br /> T EPA 413.1 413.2 418.1 <br /> PT ODOR <br /> RADIOLOGICAL li� �. <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 /> 100nd EPA 547 <br /> 100ml EPA 531.1 <br /> T EPA 548 <br /> T EPA 549 <br /> T EPA 632 -- <br /> T EPA 8015M <br /> T 0A1QC <br /> OTAMBER <br /> 8 OZ.JAR <br /> 32 OZ.JAR <br /> SOIL SLEEVE <br /> PCB VIAL <br /> PLASTIC BAG <br /> "'Mi IRON <br /> EN <br /> Comments: <br /> Sample Numbering Completed By: I Dete/Time: <br /> V vlJ IN:\D0CS1W P80\LAB DOCS\FDRMSISAMREC2WPDI <br />