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Laboratories Inc. _ <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1708750 Page 3 of 4 <br /> COOLER RECEIPT <br /> BC LABORATORIES INC. FORM Page "t <br /> Submission#: ( `� <br /> SHIPPING CONTAINER <br /> SHIPPING INFORMATION FREE LIQUID <br /> Fed Ex ❑ UPS❑ Ontrac❑ Hand Delivery ElIce Chest None ❑ Box El YES NO ❑ <br /> j <br /> BC Lab Field Service 1( Other❑(Specify) Other ❑(Specify) S <br /> Refrigerant: ll&e*"K Blue Ice❑ None❑ Other❑ Comments: <br /> Custody Seals `#r <br /> } z None[ Comments: <br /> d } <br /> All samples received? Yes No❑ All samples containers intact? Yes No 11Description(s)match COC? Yes No E3 <br /> Emissivity: Container: Thermometer ID: Date/Time <br /> COC Received <br /> YES ❑ NO 'C / (C ) 'C Analyst Init € <br /> Tem erature {A 1 <br /> SAMPLE NUMBERS <br /> .SAMPLE CONTAINERS t 2 3 4 6 6 7 9 9 10 <br /> T PE UNPRES <br /> 3 <br /> 4oz/8oz/16oz PE UNPRES <br /> 2oz Cr" <br /> T INORGANIC CHEMICAL METALS <br /> INORGANIC CHEMICAL METALS 40z 1 80/160z <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 2oz.NITRATE/NITRITE <br /> PT TOTAL ORGANIC CARBON <br /> PT CHEMICAL OXYGEN DEMAND <br /> i <br /> PIA PHENOLICS I <br /> 40.1 VOA VIAL TRAVEL BLANK <br /> 40mi VOA VIAL <br /> i <br /> T EPA 1664 <br /> I <br /> PT ODOR <br /> RADIOLOGICAL <br /> i <br /> BACTERIOLOGICAL <br /> I <br /> 40 ml VOA VIAL-504 <br /> T EPA 508/6088080 <br /> i <br /> T EPA 515.18150 <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> I <br /> 40m1 EPA 547 <br /> 40mlEPA 531.i <br /> 8 o EPA 548 <br /> T EPA 549 <br /> T EPA 8015M <br /> T EPA 8270 <br /> 8oz/16oz/32oz AMBER <br /> 8oz/16oz 132oz JAR <br /> SOIL SLEEVE <br /> PCB VIAL <br /> PLASTIC BAG <br /> TEDLARBAG <br /> FERROUS"11�15N- - - - <br /> ENCORE <br /> SMART KIT ... _ ...... .. <br /> ....... <br /> SUMMA CANISTER <br /> Comments: /. Rev 21 0512312016 <br /> Sample Numbering Completed By: ![1 Date(i imet�.� �sFORMS na c e <br /> 1 awPoo��womvede�" <br /> The results in this report apply to the samples analyzed in accordance with the chain of custody document This analytical report must be reproduced in its entirety. <br /> All results listed in this report are for the exclusive use of the submitting party. BC Laboratories,Inc.assumes no responsibility for report alteration,separation,detachment or third party interpretation. <br /> Report ID: 1000593760 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.bclabs.com Page 5 of 30 <br />