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Laboratories, Inc. <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1213761 Page 2 of 2 • <br /> BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev.No.12 06124!08 Page of <br /> Submission-ht: <br /> SHIPPING INFORMATION SHIPPING.CONTAINER <br /> Federal Express El UPS 0 ' Hand Delivery 0 Ice Chestgr None 0 <br /> BC Lab Field Service r70 Other 0(Specify)_ <br /> T' Box 0 Other 0(Specify)_ <br /> 'Refrigerant: lceO7 Blue Ice C1 None o Other 0 Comments: <br /> iners 0 None <br /> Ice Chest 0 C-J <br /> Custody Seals 0� 0::'Comments- <br /> Intac:t7 Ye Yes 0 No n <br /> All samples received? yes No All samples containers intact? Ye Y2 moo Description(s)match CDC? YesK:No 0 <br /> COC Received --- Emissivity: 0 Fig Container. Thermometer ID:1-1-1 <br /> YES 0 NO <br /> Temperature:A 3.7 *C C 3.96- ^C Analyst Init 'U-)W <br /> SAMPLE CONTAINERS <br /> 3 . q . 5 <br /> OtGENERAL MWERALI GENERAL PHYSICAL <br /> J f'FEUNPRESERVED f3c)-Z- C, C <br /> OT INORGANIC CHEMICAL METALS <br /> Xr INORGANIC CHEMICAL METALS <br /> PT NITROGEN FORMS <br /> FT TOTAL SULFIDE <br /> 10r-NITRATE I NITRITE <br /> FT TOTAL ORCAMC CARBON <br /> XLT-ox <br /> PTCHEM ICA L OXYGEN DEMAND <br /> PtA PUML16 <br /> 40-1 VOA VIAL TRAVEL BLANIC <br /> 40.1 VGA VIAL -615 11 4 2 f it <br /> FT ODOR <br /> .RADIOLOGICAL <br /> AA-_CTERJOLOGICAI, <br /> 40-1 VOA VIAL-StH <br /> OT EPA SM60919080 <br /> OT EPA 525 <br /> T EPA 5'S TRA VEL BLANK <br /> I00w1 EPA 547 <br /> 110.1 EPA 53 1.1 <br /> TEPA 548 <br /> PT EPA 549 <br /> P_T EPA M <br /> QT EPA 90 ISM <br /> OT AM DER <br /> L JAR <br /> 32 0?-JAR <br /> SOIL SLEEVE <br /> B VIAL <br /> PLASTIC BAC <br /> FERROUS lRorj <br /> ENCORE <br /> Omments: <br /> "MIP10 Numbering Completed By: A"W DaLol <br /> I C .Car-rested <br /> ........................ <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 parry interpretation. <br /> 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.bciabs.com Page 4 of 33 <br />