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M� Laboratories Inc. i <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1007458 Page 2 of 2 <br /> BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev.No.12 06124108 Page Of <br /> Submission#: [Q-0'7(-17X <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express ❑ UPS❑ Hand Delivery ❑ Ice Chesoo None ❑ <br /> BC Lab Field Service IP Other O(Specify) Box ❑ Other ❑(Specify) <br /> Refrigerant: Ice W2 Blue Ice O None❑ Other❑ Comments: <br /> Custody Seals Ice Chest 0 Containers None Comments: <br /> Intact?Y Intact?Yes 0 No <br /> All samples received? Yes�g No❑ All samples containers intact? Yes 0� No❑ Description(s)match COC? YesZP No ❑ <br /> COC Received Emissivity:CO), Container. VCAA Thermometer ID–--W-7-2 <br /> � e DatetTme(P I ]() 212d <br /> Temperature:A <br /> YES 1:1 No _ _.' _C ! C e C Analyst Initi--- <br /> SAMPLE CONTAINERS t 1 2 1 3 4 6 6 7 a 6 10 <br /> OT GENERAL MINERAL/GENERAL PHYSICAL <br /> PT PE UNPRESERVED <br /> OT INORGANIC CHE&ICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 2m NITRATE/WRITE <br /> PT TOTAL ORGANIC CARBON <br /> PT TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> PtA PHENOLICS <br /> 40ml VOA VIAL.TRAVEL BLANK <br /> 40.1 VOA VIAI, 1 1 I 1 ) l 1 1 1 1 1 1 I 1 1 1 I <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 515.118150 <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> 100m1 EPA 547 <br /> 100m1 EPA 531.1 <br /> T EPA 548 <br /> T EPA 549 <br /> OT EPA 632 <br /> T EPA 8015M <br /> T AMBER <br /> 8 OZ JAR <br /> 32 OL JAR <br /> SOIL SLEEVE <br /> PCB VIAL <br /> PLASTIC BA <br /> FERROUS MON <br /> ENCORE <br /> Comments: <br /> Sample Numbering Completed By: Date/Time: <br /> A=Actual ! C=CorrectedtH:IDOCSIWPa01LAELDOCSIFORMSISAMREC2.WPOI <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 alterations separation,detachment or third party interpretation <br /> 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.bclabs.com Page 4 of 12 <br />