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Laboratories Inc. I <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1200695 Page 2 of 2 <br /> BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev.No.12 06041De Page I Of_ <br /> Submission#: 2®RW"t��yy 5 <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express ❑ r�U(PS❑ Hand Delivery ❑ Ice Chest K. None ❑ <br /> BC Lab Field Service Y� Other❑(Specify) Box ❑ Other ❑(Specify) <br /> Refrigerant: Ice plD Blue Ice❑ None❑ Other❑ Comments: <br /> Custody Seals Ice Chest D. Con ameFs p None yO Comments: <br /> Inta'cl?-Yes. -ND❑ lntiid7.a•�ska-"No��''. <br /> All samples recelved7 YesV No❑ All samples containers intact? Yes` No❑ Descriptionis)match COC? Yes�No ❑ <br /> COC Received Emissivity: C"SX, Container. Thermometer1l): \y1� DatelTime t-1 -Ise <br /> YES 1NC! Temperature:A O 'C f C l tG 'C ' Analystlnit Stj I <br /> I SAMPLE NUMBERS <br /> SAMPLE CONTAINERS 1 2 3 4 5 1 10 <br /> OT GENERAL MINERAL GENERAL PHYSICAL ` <br /> PT PE MPRESER VED C- <br /> T INORGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS 1 <br /> PT CYANIDE <br /> PT NITROGEN FORAMS <br /> PT TOTAL SULFIDE <br /> 2—NIRA TE I NITRITE <br /> PT TOTAL ORGANIC CARBON <br /> VTTOx <br /> PT CHEMICAL OXYGEN DEMAND <br /> PtA PHENOLICS . <br /> 40mt VOA VIAL TRAVEL BLANK <br /> 40.1 VOA VIAL <br /> T EPA 413.7 4132 418"1 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 ml VOA VIAL"504 <br /> T EPA 508/60 MIRI <br /> T EPA 515.1!8150 <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> 300m)EPA 547 <br /> 1DOml EPA 531.1 <br /> 7 EPA 548 <br /> T EPA 549" <br /> T EPA 632 <br /> T EPA 8015M <br /> -OTAMBER <br /> 8 02 JAR <br /> 32 OL JAR <br /> SOIL SLEEVE <br /> PCB VL1L <br /> PLASTIC RAG <br /> FERROUsIRON <br /> ENCORE <br /> Commenls- <br /> Sample Numbering Completed By; Oalernme: <br /> A=Actual 1 C=Corrected (n!%DDCS uraataa_DOCSIFORMS%SAMReczwt+nl <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 parry.BC Laboratories,Inc.assumes no responsibility for report alteration,separation,detachment or third party interpretation. <br /> 4100 Atias Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.bciabs.com Page 4 of 19 <br />