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BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev.No. 10 01/21/04 Page _ Of <br /> Submission #: — t9 Project Code: _ <br /> TB Batch # <br /> SHIPPING INFORMATION SF�IPPING CONTAINER <br /> Federal Express ❑ USS ❑ Hand Delivery ❑ pi <br /> BC Lab Field Service p� Ice Chest None ❑ <br /> Other ❑ (Specify) Box ❑ Other ❑ (Specify) <br /> Refrigerant: Ice Blue Ice ❑ None ❑ Other ❑ Comments: <br /> Custody Seals: Ice Chest ❑ Containers ❑ None <br /> l�Comments: <br /> Intact? Yes ❑/No ❑ Intact? Yes ❑ No ❑ / <br /> All samples received? Yes !7 No ❑ All samples containers intact? Yes [X No ❑ <br /> ODescription(s) match COC? VesW� No ❑D <br /> COC Received Ice Chest ID h 11, EmissivityI III Date/Time tL111 C I <br /> Ca'YES ❑ NO Th remperatu re: C Containerta 11" <br /> er D' f T Analyst Init <br /> SAMPLE CONTAINERS <br /> QT GENERAL MINERAL/GENERAL PHYSICAL <br /> PT PE UNPRESERVED <br /> T INORGANIC CHEMICAL METALS t� <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 202 NITRATE/NITRITE <br /> 100m1 TOTAL ORGANIC CARBON <br /> OT Tox <br /> PT CHEMICAL OXYGEN DEMAND <br /> PIA PHENOLICS <br /> 40ml VOA VIAL TRAVEL BLANK <br /> 40-1 VOA VIAL 1 1 1 1 <br /> TEPA 413.1 41 J.2 418,1 I <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40-I 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 /> 100m1 EPA 547 <br /> I OOmI EPA 531.1 <br /> T EPA 548 <br /> T EPA 549 <br /> T EPA 632 <br /> T EPA 801 SM <br /> T A/ C <br /> T AMBER <br /> 8 OZ.JAN <br /> 32 OZ.JAR <br /> SOIL SLEEVE <br /> PCB VIAL <br /> PLASTIC BAG <br /> i NERROU8IRON <br /> ENCORE <br /> Comments: <br /> Sample Numbering Completed By: - Date/Time: n ^ <br /> oIIoc) H iD0C51WPa01lAB pp CS1FORMSISAMREC2 WPDJ <br />