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F] <br />[1 <br />n <br />n <br />11 <br />11 <br />Laboratories, Inc. Ii <br />Environmental Testing Laboratory Sind 1949 <br />Chain of Custody and Cooter Receipt Form for 1008301 <br />2of2 <br />BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev. No. rte W24loa Page .J Of <br />Submission 9t: <br />SHIPPING INFORMATIONHIPPING <br />FF-d.ralress ❑ tJPS ❑ Nand Delivery ❑ <br />Service YU Other ❑ (Specify) <br />CONTAINER <br />!ce Chest None ❑ <br />Box ❑ Other ❑ (Specify) <br />Refrigerant: Ice Blue Ice O None ❑ Other 0 Comments: <br />Custody Sealsce <br />Chest O <br />Intact? Yes_Q No QIntac[7 <br />Containers O <br />Yes No <br />None �F- Comments: <br />All samples received? Yes No ❑ All samples cooyntainers Intact? Yes No ❑ Description(s) match COC? Yes/No0 <br />COC Received Emissivity: f Container: ]1( Thermometer ID: + DatelFimek.AIi oi`(0 <br />YES 0 NO 2 —t --T too <br />Temperature: A �. , t •C 1 C � • °C Analyst Init i <br />SAMPLE CONTAINERS t 2 a1 4 5 s > 8 a 90 <br />QT GENERAL MINERAU GENERAL PHYSICAL <br />PT PE "R.ESER VED <br />7 MORrANIC CHEMICAL METALS <br />PTI ORGANIC CHEMICAL METALS <br />PT CYANIDE <br />PT NITROGEN FORA95 <br />PT TOTAL SULFIDE <br />? oL NITRATE IN ITRITE <br />PT TOTALORGAN)Cghmm <br />PT 70X <br />PT CHEMO Ca t, OYt'G EN DENIAND <br />PtA PHENOLICS <br />4OL-1 VOA VIAL TRAVEL BLA14K <br />AA ed [�CZ <br />j2MI VOA 'VIAL , t I f 1 t r I +i� I t t <br />T EPA 443.L 44].7 418.1 <br />PT gpog <br />RAD10L0 iCAL t <br />DACTERIOLO AL <br />40 ml V A UAL- 504 <br />OT EPA 508/6MOSO ' <br />T EPA 5i3.118150 i <br />T EPA 525 <br />T PA 375 TRAVEL BLANK <br />I D0m1 EPA 547 <br />I00MI EPA 537.1 <br />T EPA 548 <br />T EPA 549 <br />T EPA 632 <br />T EPA 0015M <br />T AMBER <br />B OZ. JAR <br />32 04 J. <br />7L5 ' VE <br />.MB VIA, <br />PLASTIC BAG <br />F RROus IRON <br />HEE <br />£NCORf . '' '' <br />5" ampTeiJumoerino Completed <br />A = Actual 1 C = Corrected <br />80XLAa_D0CS F0RN1E15AMREC2.WP01 <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, asstunes no responsibility for report alteratiorl separation, detachment or third party interpretation <br />4100 Atlas Court Bakersfield, CA 93308 (661) 327-4911 FAX (661) 327-1918 www.bolabs.com page 4 of 29 <br />