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I ARnRATORIES INC. SAMPLE RECEIPT FORM Rev. No. to o1121/04 Page _ Of <br />Submission #: ( <br />Project Code: <br />TB Batch # <br />SHIPPING INFORMATION% <br />eral Express ❑ UPS ❑ Hand Delivery of <br />BC Lab Field Service ❑ Other ❑ (Specify) <br />SFOPPING CONTAINER <br />Ice Chest E" None ❑ <br />Box ❑ Other ❑ (Specify) <br />Refrigerant: Ice bd Blue Ice ❑ None ❑ Other ❑ <br />Comments: <br />stody Sealslce <br />Chest ❑ j <br />[Containers ❑ <br />None <br />Comments: <br />AN samples received? Yes J No D AN samples containers intact? Yes <br />No ❑ Descrip8on(s) match COC? Yes VNO 0 <br />COC Received <br />E�1 YES �O <br />Tice Ch <br />Temperature- est ID <br />emper <br />Emissivity (i-4 Daterrime t -t <br />°C Container ' r Ii JL <br />Analyst snit <br />SAMPLE CONTAINERS 1 2 3 <br />4 5 8 7 8 9 t0 <br />GENERAL MINERAL/ GENERAL PHYSICAL <br />P'r PE UNPRESERVED <br />It INORGANIC CHEMICAL METALS <br />INORGANIC CHEMICAL METALS <br />Vr CYANIDE <br />NITROGEN FORMS <br />TOTAL SULFIDE <br />2oz. NITRATE I NLTRTPE <br />TOTAL ORGANIC CARBON <br />TOX <br />PT CHEMICAL OXYGEN DEMAND <br />PHENOL" <br />oil VOA VIAL TRAVEL BLANKf� <br />VOA VIAL <br />T EPA 413.12 41.3.2 418.1 <br />ODOR <br />IOLOGICAL <br />$ACTERIOLOGICAL <br />tni VOA VIAL -SM <br />EPA <br />EPA 515.118150 <br />EPA -525 <br />EPA 525 TRAVEL BLANK <br />100+n1 EPA 549 <br />EPA 53LI <br />EPA 548 <br />T EPA 549 <br />EPA 632 <br />EPA 8015M <br />AMBER <br />OZ AR <br />OZ AR <br />SOIL SLEEVE <br />B VIAL <br />ASTIC BAG <br />FERROUSIRON <br />NCO" <br />Comments: <br />Sample Numbering Completed By: Daten1me: <br />t-✓[fisIDOCStWP80VtAa_DOCStFORMStSAMREC2.YYPDf <br />