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I�IiI <br />l_ 1 <br />BC LABORATORIES INC. SAMPLE RECEIPT FORM Rear. No. 12 06124/08 Page L Of <br />Submission #• tD —UIS107 <br />SHIPPING INFORMATION SNIPPING CONTAINER <br />Federal Express UPS ❑ Hand Delivery ❑ Ice Chest None ❑ <br />BC Lab Field Service ❑ Other ❑ (Specify)__. Box O Other ❑ (Specify_ <br />Refrigerant: lc7eO Blue Ice O None ❑ Other ❑ Comments: <br />Custody SealsIce Chest Containers ❑ - None O Comments: <br />Intact? YNo ❑ <br />es intact? Yes ❑ No ❑ <br />All samples received? Yes No ❑ All samples containers intact? Yes No ❑ Description(s) match COC? Yes W No ❑ -- <br />COC Received Emissivity: _ Container: � Thermometer ID:4*3 tt,, <br />DaterTime 3-1p 0 ®.1 <br />ES ❑ NO <br />Temperature:A ✓ °C / C 'Z� °C Analystlnit <br />Date/Time: dr-DCcI <br />M�/-[H100CSkWP8JILA6_„O::S,rORNISISAWIREC2. iMPJ; <br />SAMPLE CONTAINERS t z s a 5 s e 9 19 <br />QT GENERAL MINERAL/ GENAPHYSICAL <br />PT ODOR <br />PT PE UNPRESERVED <br />BACrER10LOG ICAL <br />T INORGANIC CHEMICAL <br />40 mI VOA VIAL. 501 <br />PT INORGANICCHEMICAL <br />' <br />T EPA 515.113150 <br />PT C!'ANIDE <br />T EPA 525 <br />PT NITROGEN FORMS <br />' <br />100mi EPA 54; <br />PT TOTAL SULFIDE <br />100m1 EPA 53L7 <br />2oz. NITRATE /NITRITE <br />T EPA 549 <br />PT TOTAL ORGANIC CARBON <br />T EPA 632 <br />PT TOk <br />T AMBER <br />PT CHEMICAL OXYGEN DEhLAND <br />8 OZ. JAR <br />PtA PHENOLICS <br />SOIL SLEEVE <br />40m1 \'OA VIAL TR-kVEL BLAJNK <br />A L7' <br />PCB 1"I -NL <br />40ml � DA VIAL <br />PL.aSTIC Bm <br />OT EPA 413.1. 413.2. 418.1 <br />ENCORE <br />Date/Time: dr-DCcI <br />M�/-[H100CSkWP8JILA6_„O::S,rORNISISAWIREC2. iMPJ; <br />PT ODOR <br />RADIOLOGICAL <br />BACrER10LOG ICAL <br />40 mI VOA VIAL. 501 <br />•T EPA 508/608/8080 <br />' <br />T EPA 515.113150 <br />T EPA 525 <br />T EPA 525 TP -A% -EL BLANK <br />' <br />100mi EPA 54; <br />100m1 EPA 53L7 <br />T EPA 548 <br />T EPA 549 <br />T EPA 632 <br />T EPA 8015%'1 <br />T AMBER <br />' <br />8 OZ. JAR <br />32 OZ. JAR <br />SOIL SLEEVE <br />' <br />PCB 1"I -NL <br />PL.aSTIC Bm <br />FERROUS IRON <br />ENCORE <br />Comments: <br />Sample Numbering Completed By: <br />A = Acloal C = Correzted <br />Date/Time: dr-DCcI <br />M�/-[H100CSkWP8JILA6_„O::S,rORNISISAWIREC2. iMPJ; <br />