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t <br /> Laboratories, Inc. W"i <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1008809 Page 2 of 2 <br /> SAMPLE RECEIPT FORM Rev.No.12 06124/08 P <br /> BC LABORATORIES INC. <br /> ae Of <br /> Submission#: to—o SHIPPING CONTAINER <br /> SHIPPING INFORMATION ice Chest p None ❑ <br /> Federal Express ❑ UPS❑ Hand Delivery F1Box ❑ Other ❑(Specify} <br /> BC Lab Field Service'W Other❑(Specify)— <br /> Refrigerant: <br /> Specify) —.Refrigerant: Ice Blue ice❑ None❑ Other❑ Comments: <br /> Custody Seals ice Chest❑ Containers❑ Noneld Comments: <br /> Intact?Yes No❑ Intact7 Yes ❑ No <br /> All samples received? Ye ❑ No❑ All samples containers intact? Y No❑ Description(s)match COC? Yp El'No ❑ <br /> aas <br /> Container: ThermometerID: I�� Date(rimeSp57-25_1D <br /> COC Received Emissivity: D��1 Analyst Init S 1,:7V:t <br /> OYES 0 NO Temperature:A 3�?� —'C 1 C 3' `C <br /> � s e to <br /> SAMPLE CONTAINERS t 2 <br /> 3 4 s 8 <br /> QT GENERAL MINERAU GENERAL PHYSICAL <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 /> 2=NITRATE 1 NITRITE <br /> PT TOTAL ORGANIC CARBON <br /> PT TOA <br /> PT CHEMICAL XYGEN DEMAND <br /> PtA PHENOLICS <br /> 40.1 VOA VIAL TRAVEL BLANK 1 1 1 I 1 11 <br /> 1 1 I { 1 l 1 1 l 1 <br /> 40.1 VOA VIAL <br /> T EPA 413.1 413.2 418.1 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40.1 VOA VIAL-508 <br /> T EPA 508/608/8080 <br /> T EPA 515.118150 <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> 100.IEPA 547 <br /> 100.1 EPA 531.1 <br /> T EPA 548 <br /> T EPA 549 <br /> T EPA 632 <br /> T EPA 801511 <br /> T AMBER <br /> 8 OL JAR <br /> 32 OL JAR <br /> SOIL SLEEVE <br /> PCO VIAL <br /> PLASTIC BAG <br /> FERROUS IRON <br /> ENCORE <br /> Comments: [Time: <br /> Sample Numbering Completed By._ Datel�yi=i <br /> � t;DOCSiWP80\LAB D0CS\F0RMS\SAMREC2.WP0 <br /> A=Actual I C=Corrected <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 patty interpretation <br /> 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.bclabs.com Page 4 of 12 <br />