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BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev.No. 10 01121/04 Page —Of <br /> Submission #: Project Code: T8 Batch # <br /> SHIPPING INFORMATION SLIPPING CONTAINER r <br /> Fe4o 1 Express ❑ lips ❑ Hand Delivery ❑ Ice Chest [j None ❑ <br /> Field Service e( Other❑ ISpecify) Box ❑ Other ❑ (Specify) <br /> Refrigerant: Ice Blue Ice ❑ None ❑ Other ❑ Comments: <br /> Custody Seals: Ice Chest ❑ Containers ❑ None f� Comments: <br /> Intact?Yes/❑No ❑ Intact?Yes ❑ No <br /> AN samples received? Yes IJ No O All samples containers intact? Yes No❑ Description(s)match COC? Yes Cf No ❑ <br /> COC Received Ice Chest 10 t> Emissivity Date[Time Ah-41106 <br /> BYES ® NO Temperature: "C Container <br /> Th O• Analyst Init <br /> SAMPLE CONTAINERS t 2 3 4 S 6 7 8 9 10 <br /> T GENERAL MINERAL/GENERAL PHYSICAL <br /> PT PE UNPRESERVED <br /> T INORGANIC CHEMICAL METALS <br /> INORGANIC CHEMICAL METALS <br /> CYANIDE <br /> FT NITROGEN FORMS <br /> El TOTAL SULFIDE <br /> NITRATE I NITRITE <br /> 100ml JOTAL ORGANIC CARBON <br /> T TOX ~ <br /> EE CHEMICAL OXYGEN DEMAND <br /> P -' NOLICS <br /> A VIAL TRAVEL BLANK <br /> OA VIAL <br /> 01 EPA 413.1,413.2.4 18.1PT _ <br /> ODOR <br /> DIOLOGICAL <br /> B CTERIOLOGICAL �^ <br /> 40 1 VOA VIAL-504 — <br /> OT EPA 508/608/8080 <br /> T EPA SI5.1/8150 y`- <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> 180m1 EPA 547 <br /> 100ml EPA 531.1 <br /> Q1 EPA 548 <br /> EPA 549 <br /> T EPA 632 <br /> EPA 8915M <br /> T AMBER — <br /> 8 OZ,JAR <br /> 32 OZ.JAR - �- <br /> 1L SLEEVE <br /> 8 VIAL <br /> PR' C BAG <br /> F S1RON # <br /> ENCORE <br /> omments: <br /> ample Numbering Completed By: Date/Time: <br /> (H:\D0CSXWP8WLA8 DOCW,-)R'.^.SiSAMRt_�' .VJPfIi <br />