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BC LABORATORIES INC. SAMPLE RECEIPT FORM Rov.No.12 06124108 , Page—1 Of <br /> Submission#:N-C) I I <br /> SQuIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express z UPS 0 Hand Delivery 0 lee Chesty None 0 <br /> BC Lab Field Service 0 Other 0(Specify) Box 0 Other 0(Specify) <br /> lRefrigerant: 6V Blue lceo None 0 Other 0 Comments: <br /> Custody Seals Ice Chest ri Cont4ijigs 0 None(2V Comments: <br /> I <br /> Intact?Yes.D No Q la 0 No 0 1 <br /> All samples received? Yes)W No o All samples containers intact? YesV No 0 Descriptlon(s)match COC? Yes, No 0 <br /> COC Received Emissivity: *96 Container: Thermometer ID; � Date/Time <br /> �CVYES © NO <br /> 1C C 1C <br /> Temperature:A Analystink LT <br /> I <br /> SAME UMBERS <br /> SAMPLE CONTAINERS 1 2 3 4 6 6 7 0 9 <br /> OT GENERAL MINERAL!GENERAL PHYSICAL <br /> PT PE UNPRESERVFD <br /> OT lNgRGANIC 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 ORGANJC CARBON <br /> PT TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> PIA PHENOLICS <br /> 40ml VOA VIAL TRAVEL BLANK <br /> 40m1VOAVIAL <br /> QT EPA 413.1 413.2.41&1 <br /> PT ODOR <br /> IOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 ml VOA VIAL-%4 <br /> QT EPA 508/608MM <br /> 0 <br /> UICAL OXYGEN DEMAND <br /> 1 0' <br /> I <br /> PT <br /> BA <br /> S2T EPA 515.1/8150 <br /> OT EPA 525 <br /> OT EPA 525 TRAVEL-BLANK <br /> 100ml EEA 547 <br /> 100ta1 EPA 531.1 <br /> QT EPA 548 <br /> QT EPA 549 <br /> OT EPA 632 <br /> OT EPA SO ISM <br /> OT AMBE It <br /> 8 OL JAR <br /> 32 O.Z.JAR <br /> SOIL SLEEVE <br /> PCB LJAL <br /> PLASTIC RAG <br /> FE §IRON <br /> JENCORE <br /> Comments: <br /> Sample Numbering Completed By., ( ,4M(Yj Date/Time: 7&'V -q7o <br /> A=Actual 1 C=Corrected pi:MDOCSIWP80UAB�_DOCStFORMSISAMREC2.WPDI <br />