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am Laboratories Inc.—W I . <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1200786 Page 2 of 2 <br /> Bc LABORATORIES INC. SAMPLE RECEIPT FORM Rev.No.12 a6124*8 Page O _ <br /> Submission# �-- )O 1, <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express ❑ UPS❑ Hand Delivery ❑ Ice Chest None ❑ <br /> BC Lab Field ServiceCt- Other❑(Specify) Box ❑ Other ❑(Specify) <br /> Refrigerant Ice.f- Blue ice❑ None❑ Other❑ Comments: <br /> Custody Seats Ic Guest p: Gonta ni=is'L7 None Vomments: <br /> IitlactTYes T1oO Iofaet7.Yes 0 No ❑ <br /> All samples received? Y. No D All samples containers intact? Yes57 No❑ Description(s)match COC? Y No ❑ <br /> COC Received Emissivity: � Container: f6 Thermometer ID: M Daternme 1-12:-12- <br /> .-1Iy ❑ Na <br /> ,Jp 2215 <br /> Temperature:A �.� `C 1 C �l!J `C Analyst Init <br /> SAMPLE NUMBERS <br /> SAMPLE CONTAINERS 2 s 1 4 1 s 1 s 7 e s itt <br /> OT GENERAL MINERW GENERAL PHYSICAL <br /> Pl'IEUNPRESERVED '5 G C <br /> t, <br /> T INORGANIC CHEMICAL ACETALS <br /> PT INORGANIC CHEMICAL METALS <br /> t 1 C- <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 2—NITRATE/NITRITE <br /> PT TOTAL ORGANIC CARBON <br /> PT TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> 1PtA PHENOLICS <br /> 40ml VOA VIAL TRAVEL BLANK �1 <br /> 40m1 VOA VIAL 1 1 1 A I 1 I ) 1 I f 1 t 1 1 I I <br /> T EPA 413.1 4131.438.1 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 ml VOA VIAL-504 <br /> T EPA SO8I0818080 <br /> T EPA 515.119150 <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> I OOm]EPA 547 <br /> I ODm1 EPA 531.1 <br /> T EPA 548 <br /> T EPA 549 <br /> T EPA Gil <br /> T EPA 8015M <br /> OTAMBER <br /> 8 OZ JAR <br /> 32 OZ JAR <br /> SOIL SLEEVE <br /> PCB VIAL <br /> PLASTIC BAG <br /> FERROUSIRON <br /> ENCORE <br /> ample Numbering Completed By: Date/Tlme: <br /> =Actual / C=Gorrectod IBUDOCS%WPOett.AS D0CSIFDRMS%SAMREC2.WPDi <br /> The results in this report apply to the samples analyzed in accordance with the chain ojcustody 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 /> 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.bclabs.com Page 4 of 29 <br />