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EIC LABORATORIES INC. SAMPLE RECEIPT FORM Rev.No.12 06124108 Page-j Of <br /> Submission#' <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express ` UPS 0 Hand Delivery0 Ice Chest pg. None D <br /> BC Lab Field Sece 0 Other D(Specify) — Box 0 Other 0 (Specify) <br /> Refrigerant: IceBlue fee 0 None D Other 0 Comments' <br /> Custody Seals Ice Chest Containers D None El Comments: <br /> Intact? No_Q Intact?Yes 0 No 0 <br /> O" <br /> All samples received? Yes No 0 All samples containers intact? Yes Z No 0 Description(s)match COC? YeNo C3 <br /> COC Received Emissivity: Container: A& Thermometer ID: --W39- DatelTime 2:Tj to <br /> YES F-1 NO Temperature: `C C C Ana I of" > <br /> A Anal Init <br /> SAMPL E NUMBERS <br /> SAMPLE CONTAINERS i Z 3 4 5 6 7 8 9 10 <br /> OT GENERAL MINERAL/GENERAL PHYSICAL <br /> HYS' <br /> PT PE UNPRESERVED <br /> —QT INORGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 2oz.NITRATE I NITRITE <br /> FT TOTAL ORGANIC CAR-BON <br /> PT TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> PtA PHENOLICS <br /> Owl V VIAL I-RAVEL BLANK <br /> 40ml VOA VIAL 9 1 )4 zJ,-7-1 1A ,A <br /> !2T EPA 413.1.413.2 418.1 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 ml VO A VIAL-504 <br /> T EPA 508Y608/8080 <br /> QT EPA 515.1/8130 <br /> OT EPA 525 <br /> OT EPA 525 TRAVEL BI-A.NK-- <br /> 100ml EPA 547 <br /> 100ml EPA 531.1 <br /> LT EPA 548 <br /> OT EPA 549 <br /> Q-1-EPA 632 <br /> QT EPA 8015NI_ r <br /> OT AMBER <br /> 8 OZ.JAR <br /> 32 OZ.JAR <br /> SOIL SLEEVE. <br /> PCR VIAL <br /> PLASTIC BAG <br /> FERROUS IRON <br /> ENCORE <br /> Comments: <br /> Sample Numbering Completed By: DatetTime: 7— <br /> A=Aclual 1 C=Corrected IH:UDOCSIVVP8DkLAB-DOCS\FORNIS\SAMREC2.WPDI <br />