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ORATORIES INC. <br />SAMPLE RECEIPT FORM o. s 06/12/03 Page Ofssion <br />E#: <br />Project Code: 111�B Batch # <br />SHIPPING INFORMATION <br />[FederalExprq,ss ❑ UPS ❑ Hand Delivery ❑ <br />C`Lab Field Serviced Other ❑ (Specify) <br />V <br />S IPPING CONTAINER <br />Ice Chest None ❑ <br />Box ❑ Other ❑ (Specify) <br />Refrigerant: Ice ❑ Blue ice <br />None ❑ Other ❑ Comments: <br />Custody Seals <br />Custody <br />Ice Chest ❑ <br />intact? Yes : fl No O <br />ners Q <br />Eta..Yes 'O =No s0, <br />Non Comments: <br />r <br />All samples received? Yes �, No o <br />All samples containers intact? Yes No ❑ Description(s) match COC? Yes /' No ❑ <br />I <br />COC Received <br />\XYES ❑ NO <br />Ice Chest ID %` Emissivity] Date/Tim ,iGw1aeLa <br />Temperature: 10C Container <br />Thermometer ID: . Analyst Init <br />SAMPLE CONTAINERSs <br />a s 6 7 s s 10 <br />QT GENERAL MINERAL/ GENERAL PHYSICAL <br />PT PE UNPRESERVED <br />QT INORGANIC CHEMICAL METALS <br />PT INORGANIC CHEMICAL METALS <br />PT CYANIDE <br />PT NITROGEN FORMS <br />PT TOTAL SULFIDE <br /><-'+ <br />2oz. NITRATE / NITRITE <br />100mt TOTAL ORGANIC CARBON <br />r' <br />T TOX <br />�..y� <br />CHEMICAL OXYGEN DEMAND <br />a <br />100ad PHENOLICS <br />11PT <br />40nd VOA VIAL TRAVEL BLANK <br />)^ <br />VOA VIAL <br />T EPA 413.1,413.2,418.1 <br />C"J <br />PT ODOR <br />RADIOLOGICAL <br />BACTERIOLOGICAL <br />40 mi 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 />T R1150 WN <br />122=1- <br />jj i <br />IOOm1EPA 531.1 <br />QT EPA 548 <br />QT EPA 549 <br />QT EPA 632 <br />QT EPA 8015M <br />T QA/QC <br />T AMBER <br />8 OZ. JAR <br />32 OZ. JAR <br />SOIL SLEEVE <br />eG <br />PCB VIAL <br />PLASTIC BAG <br />--RROUS IRON, <br />:ORE <br />Comments <br />Sample Numbering Completed By: 75Qq DateMme: 02 <br />IH:IDOCSIWPSOILAS DOCSIFORMSISAMREC2.WPD] <br />