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Laboratories <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1200694 Page 2 of 2 <br /> BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev.No.12 06/24/08 Page Of_ <br /> Submission 9 <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express ❑ UPS❑ Hand Delivery ❑ Ice Chest;c- None ❑ <br /> BC Lab Field Service Other❑(Specify) Box 0 Other ❑(Specify) <br /> Refrigerant: Ice PD Blue Ice❑ None❑ Other❑ Comments: <br /> Custody Seals Ice ti st O Con atners `':? None Comments: <br /> Intact7tYes.D'Noh] Intad?Yes 11lh_ <br /> AEI samples recelved? Yes'ipNo❑ All samples containers intact? Yes`e No 0 Description(s)match COC? YestiJONo ❑ <br /> COC Received Emissivity: G, '� Container. Thermometer ID: 1 l� DatelTime 1-i ') <br /> 1 YES O NO �IU0 <br /> Temperature:A " '0<_l "C I C 1 IG ^C Arialyst lnit SNW <br /> SAMPLE CONTAINERS 1 2 a 1 4 1 3 1 s 7 1 s 1 1 to <br /> QT GENERAL MiNERAU GENERAL PHYSICAL <br /> PT PE UM'RESERVED G <br /> T INORGANIC CHEMICAL METALS <br /> PT INORGANIC CILEMI CAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 202.NrTRATE/NITRITE <br /> PT TOTAL ORGANIC CA.RItON <br /> PT TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> PtA PHENOLICS <br /> 40.1 VOA VLkL TRAVEL BLANK Y� <br /> 49ml VOA VIAL S-5 t I F 1 1 I 11 [ 1 1 1 I 1 <br /> OT EPA 413.1 4132 4I9.1 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTEIUOLOCICet <br /> 40 mI VOA VLAI,504 <br /> T EPA SUIU60MOSO <br /> T EPA 515.1/8159 <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK Ed <br /> 100mt EPA 547 <br /> 100tn1 EPA 531.1 <br /> T EPA 548 <br /> 7 EPA 549 <br /> T EPA(m <br /> T EPA SO]SM <br /> 52TAMBER <br /> 9.07-JAR <br /> 32 OL JAR <br /> SOIL SLEE V E <br /> PCB VIAL ......_.._. _._._. <br /> PLAs*nc BAG <br /> FERROUS IRON <br /> ENCORE <br /> :Ommenls• <br /> 3arnple Numbering Completed By: Daterrime: - — <br /> >t=Aclual I C=Corrected IH:Nl0051WPOCi AB DOCSLFORat515AMRECLWPD1 <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 /> 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.bclabs.com Page 4 of 17 <br />