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BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev.No.12 06/24/08 Page Of <br /> Submission #: <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express ❑ UPS ❑ Hand Delivery ❑ Ice Ches�0• None ❑ <br /> BC Lab Field Service Other ❑ (Specify) Box ❑ Other ❑ (Specify) <br /> Refrigerant: Ice Blue Ice ❑ None ❑ Other ❑ Comments: <br /> Custody Seals Ice Chest❑i Containers ❑ NoneComments: <br /> Intact?`.Yes.p No Intact?Yes O No ❑ <br /> All samples received? Yes/ No O All samples containers intact? Yese No❑ Description(s)match COC? Yes,/No ❑ <br /> COC Received Emissivity: Container:Container:(� t ThermometerlD:`1V1 Qj Date/Time <br /> YES ❑ NO <br /> A '3=3 °C / C 3•� °C Analyst Init <br /> SAMPLE NUMBERS <br /> SAMPLE CONTAINERS 1 2 3 4 5 6 7 8 s 10 <br /> OT GENERAL MINERAL]GENERAL PHYSICAL <br /> lk- <br /> PT PE UNPRESERVED <br /> T INORGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 2oz.NITRATE/NITRITE <br /> PT TOTAL ORGANIC CARBON <br /> PT TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> PLA PHENOLICS <br /> 40m]VOA VIAL TRAVEL BLANK <br /> 40m1 VOA VIAL <br /> T EPA 413.1 413.2 418.1 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 ml VOA VIAL-504 <br /> T EPA 508/608/8080 <br /> T EPA 515.1/8150 <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> 100ml EPA 547 <br /> I00mI EPA 531.1 <br /> T EPA 548 <br /> T EPA 549 <br /> T EPA 632 <br /> T EPA 8015M <br /> T AMBER <br /> 8 OZ,JAR <br /> 32 OZ,JAR <br /> SOIL SLEEVE <br /> PCB VIAL <br /> PLASTIC BAG <br /> FERROUS MON <br /> ENCORE <br /> Comments: <br /> Sample Numbering Completed By: Date/Time: <br /> A=Actual / C=Corrected IH:IDOCSIWP80\LAe DOCSIFORMSISAMREC2.WPDI <br />