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BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev. No. 12 06/24/08 Pae lof <br />Submission : — e>t � al <br />SHIPPING INFORMATION SHIPPING CONTAINER <br />Federal Express ❑ UPS ❑ Hand Delivery ❑ Ice Chest,0, None ❑ <br />BC Lab Field Service 4' Other ❑ (Specify) Box ❑ Other ❑ (Specify) <br />Refrigerant: Ice Blue Ice ❑ None ❑ Other ❑ Comments: <br />Custody Seals <br />Ice Chest <br />Inta`cti1 Yes ❑-"No D' <br />Conta'ners <br />Intact? 1(es-0, No <br />None Comments: <br />All samples received? Yes No ❑ All samples containers intact? Yes No ❑ Description(s) match COC? Yes49 No ❑ <br />COC Received Emissivity: G + a Container: Thermometer ID: 1-7-7 Date/Time <br />,OYES 0 N <br />Temperature: A � �� °C / C O's °C Analyst Init� <br />SAMELE NUMBERS <br />SAMPLE CONTAINERS 1 2 3 4 5 8 7 8 9 10 <br />OT GENERAL MINERAU GENERAL PHYSICAL <br />PT PE UNPRESERVED <br />T INORGANIC CHEMICAL METALS <br />PT INORGANIC CHEMICAL METALS <br />PT CYANIDE <br />PT NITROGEN FORMS <br />PT TOTAL SULFIDE <br />2oz. NITRATE / NITRITE <br />PT TOTAL ORGANIC CARBON <br />PT TOX <br />PT CHEMICAL OXYGEN DEMAND <br />NA PHENOLICS <br />40m1 VOA VIAL TRAVEL BLANK <br />40m1 VOA VIA 1 1 l ) t ( ) 1 ) t ) l ) ( 1 ) <br />T EPA 413.1 413.2 418.1 <br />PT ODOR <br />RADIOLOGICAL <br />BACTERIOLOGICAL <br />40 ml VOA VIAL- 504 <br />T EPA 508/608/8080 <br />T EPA 515.1/8150 <br />T EPA 525 <br />T EPA 525 TRAVEL BLANK <br />100m] EPA 547 <br />100m] EPA 531.1 <br />T EPA 548 <br />T EPA 549 <br />T EPA 632 <br />T EPA 8015M <br />T AMBER <br />8 OZ. JAR <br />32 OZ. JAR <br />SOIL SLEEVE <br />PCB VIAL <br />PLASTIC BAG <br />FERROUS IRON <br />ENCORE <br />Comments: <br />Sample Numbering Completed By: Date/Time: 5—I&DI ` IT �- <br />A = Actual / C = Corrected[H:IDOCS1WP80ILAB_DOCSIFORMSISAMREC2.WPDI <br />