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BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev. No. 12 06/24108 Page 1_ Of <br />Submission #: <br />SHIPPING INFORMATION SHIPPING CONTAINER <br />Federal Express 0 UPS 0 Hand Delivery 0 Ice Chest T2( None 0 <br />BC Lab Field Service Other 0 (Specify)— Box 0 Other 0 (Specify) <br />Refrigerant: Ice 6. Blue Ice 0 None El Other 0 Comments: <br />Custody Seals Ice Chest 0 Containers 0 None`g Comments: <br />I Intact? Yes 0 N] intact? Yes 0 No 0 <br />All samples received? Yes )6 Noo All samples containers intact? YesK No 0 Description(s) match COC? Yes No 0 <br />C Received Emissivity: D-CA5 Container: �j� Thermometer ID: \2_7 Date/Time <br />YES 0 NO Temperature: A _*C C —HILO C Analyst Init <br />SA I-IMRFRS <br />SAMPLE CONTAINERS 2 3 4 5 6 7 <br />OT GENERAL MINERAL/ GEN I ERAL PHYSICALT <br />PT PE UNPRESERVED <br />OT INORGANIC CHEMICAL METALS <br />PT INORGANIC CHEMICAL METALS <br />PT CYANIDE <br />PT NITROGEN FORMS <br />PT TOTAL SULFIDE <br />2*z. NITRATE / NITRITE <br />PT TOTAL ORGANIC CARBON <br />PT TOX <br />PT CHEMICAL OXYGEN DEMAND <br />PtA PHENOLICS <br />—Conta nerS 0 <br />Intact? <br />ie. =ON. 0 <br />Yes <br />40ml VOA VIAL TRAVEL BLANK <br />40m1 VOA VIAL <br />OT EPA 413.1,413.2.418.1 <br />PT ODOR <br />RADIOLOGICAL <br />BACTERIOLOGICAL <br />40 ml VOA VIAL- 504 <br />QT EPA 508/60818080 <br />QT EPA 515.1/8150 <br />QT EPA 525 <br />9T EPA 525 TRAVEL BLANK <br />100m1 EPA 547 <br />100m1 EPA 531.1 <br />OT EPA 548 <br />OT EPA 549 <br />OT EPA 632 <br />QT EPA 8015M <br />OT AMBER <br />8 OL JAR <br />32 OL JAR <br />SOIL SLEEVE <br />PCB VIAL <br />PLASTIC BAG <br />FERROUSIRON <br />ENCORE <br />Comments: <br />Sample Numbering Completed By: ate/Time: <br />A = Actual / C = Corrected [1(:1DOCSIWP80%LAB_DOCSIFORMSXSAMREC2.WPDI <br />