Laserfiche WebLink
BC LABORATORIES INC. <br />Adk SAMPLE RECEIPT FORM <br />No. 8 06/12/02 Page _ Of <br />Submission #: - j <br />Project Code: <br />TB Batch # <br />SHIPPING INFORMATION <br />[Federal Express ❑ UPS ❑ Hand Delivery ❑ <br />C Lab Field Service Other ❑ (Specify) <br />SHIPPING CONTAINER <br />Ice Chest None ❑ <br />Box ❑ Other ❑ (Specify) <br />Refrigerant: (Ice�6 Blue Ice <br />None ❑ Other ❑ Comments: <br />Q �• r <br />Custody Seals: <br />I es"t D, <br />Intact? Yes O+No- O <br />Containers%0 None Comments: <br />Intact?.Ye's ❑ No' <br />All samples received? Yes <br />No ❑ <br />All samples containers intact? Yes ` No ❑ <br />Description(s) match COC? Yes No ❑ <br />COC Received <br />YES ❑ NO <br />Ice Chest ID cd <br />Temperature: 14, 0 'C <br />Thermometer ID: <br />Emissivity .Q ! Date/Ti e '%'ZL.Z1 <br />Container lJt�. Ulm <br />Analyst Init <br />SA PLE CONTAINERS <br />SAMPL <br />3 4 <br />NUMBERS <br />5 6 7 a e 10 <br />QT GENERAL MINERAL/ GENERAL PHYSICAL <br />PT PE UNPRESERVED <br />T INORGANIC CHEMICAL METALS <br />PT INORGANIC CHEMICAL METALS <br />. • <br />_ <br />PT CYANIDE <br />PT NITROGEN FORMS <br />PT TOTAL SULFIDE <br />2oz. NITRATE/ NITRITE <br />100m1 TOTAL ORGANIC CARBON <br />TTOX <br />rl' CHEMICAL OXYGEN DEMAND <br />'-- <br />100m1 PHENOLICS <br />40m1 VOA VIAL TRAVEL BLANK <br />I VOA VIAL <br />•i L <br />Sample Numbering Completed By: (-cif <br />DateMme: <br />IH:IDOCS1WPa01LAB DOCSIFORMS%SAMREC2.WPDI <br />�QT EPA 413.1,413.2,418.1 <br />• • � • •---_-___-_ <br />SIIRADIOLOGICAL <br />BACTERIOLOGICAL <br />iQT EPA 508160818080 <br />QT EPA 515.1/9150 <br />QT EPA 525 TRAVEL BLANK <br />. • <br />_ <br />Sample Numbering Completed By: (-cif <br />DateMme: <br />IH:IDOCS1WPa01LAB DOCSIFORMS%SAMREC2.WPDI <br />