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BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev. No. 12 06/24/08 Pace Of <br />Submission #: <br />SHIPPING INFORMATION HIPPING CONTAINER <br />0NER <br />Federal Express 0 UPS 0 Hand Delivery D Ice Chest None <br />.fOtt, M S cif-) Box D Other O (Specify! - <br />BC Lab Field Service er ( pe <br />�Refriaerant• Ice'E Blue Ice ❑ None ❑ Other ❑ Comments: <br />Custody Seals Ice Chest ❑� Containers ❑� NaneIf. Comments: <br />Ail samples received? Yesf No Q All samples containers intact? Yes No D Description(s) match COC? Yes No 0 <br />COC Received Emissivity: _`_ Container: Thermometer ID: d Date/Time <br />:.YES ❑ NO 2 . Z Analyst Init 4. <br />Temperature: A 2 . °C / C °C Y <br />SAMPLE CONTAINERS ( 2 { 1 a 5 ' 6 l 7 l 8 l <br />tcan�ir_cA1CD ne O47V CIC61 <br />® <br />PT PE UNPRESERVED <br />T INORGANIC CHEMICAL METALS <br />PT INORGANIC CHENUCAL METALS <br />PT CYANIDE <br />I <br />PT NITROGEN FORMS E p <br />i <br />PT TOTAL SULFIDE <br />2oz. NITRATE I NITRITE l <br />1 <br />PT TOTAL ORGANIC CARBON <br />PT TOX <br />PT CHEMICAL OXYGEN DEMAND <br />PIA PHENOLICS <br />C� <br />40mi VOA VIAL TRAVEL BLANK <br />40ml VOA VIAL <br />1 <br />f <br />T EPA 413.1 413.? 418.1 1. <br />1 <br />PT ODOR l i <br />1 <br />RA1JiOLOGICA1 <br />BACTERIOLOGICAL <br />® <br />4u ml VVA VIAL• Jifa-._------ - 5 <br />OT EPA 508160818080 I <br />1 <br />T EPA 515.1!8150 { <br />T EPA 525 <br />T EPA 525 TRAVEL BLANK l <br />i <br />100m1 EPA 547 <br />I00ml EPA 53 1. t <br />T EPA 548 <br />T EPA 549 <br />T EPA 632 i <br />T EPA 8015N•1 <br />1 <br />OT AMBER <br />8 OZ. JAR <br />32 OZ. JAR <br />SOIL SLEEVE. <br />— - - --- - ......... ... <br />PLASTIC BAG <br />FERROUSIR.ON <br />ENCORE <br />Comments.- <br />Sample <br />omments:Sample Numbering Completed By:_Date/Time: t <br />A = Actual I C = Corrected jH1 MOCSVWA801LAG-DOC SIFOR+i SISAMREC2.�:PUI <br />