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BC I.-MORATORIES INC. SAMPLE RECEIPT FORM Rev. No. 12 06/24108 Page Of <br />Fs—ubmission#: I I <br />SHIPPING INFORMATION SHIPPING CONTAINER <br />Federal Express 0 UPS 0 Hand Delivery 0 Ice Chest` -None 0 <br />C Lab Field Service Other 0 (Specify) Box 0 Other 0 (Specify) <br />Refrigerant: Ice W Blue Ice D None 0 Other 0 Comments: <br />Custody Seals <br />Ice Chest 0 <br />IN. In <br />Containers El <br />None @L— Comments: <br />Intact? Yes 0 <br />Intact? Yes 0 No 0 <br />All samples received? Yes 1c, No [i <br />All samples containers intact? Yes NoO Description(s) match COC? Yes36 No 0 <br />COC Received <br />Emissivity: Container: Thermometer ID: Date/Time <br />OYES 0 NO <br />3 oc -C <br />I <br />T A / C Analyst Init <br />Temperature: <br />SAMPLE tIMRFRS <br />SAMPLE CONTAINERS 1 2 3 a 5 6 7 8 9 <br />QT GENERAL MINERAL/ GENERAL PHYSICAL <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 />2oz. NITRATE / NITRITE <br />PT TOTAL ORGANIC CARBON <br />PT TOX <br />PT CHEMICAL OXYGEN DEMAND <br />PtA PHENOLICS <br />40ml VOA VIAL TRAVEL BLANK <br />40ml 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 />OT EPA 508/608/8080 <br />gT EPA 515.1/8150 <br />iQT EPA 525 <br />OT EPA 525 TRAVEL BLANK <br />100m1 EPA 547 <br />100mi EPA 531.1 <br />QT EPA 548 <br />OT EPA 549 <br />OT EPA 632 <br />QT EPA 8015M <br />QT 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: -ID�-0 Dateri-ime:—(2-N,L-Ail <br />A=Actual / C=Corrected IH:%DOCSIWPBO%LAB_DOCS\FORMSISAMREC2.WPDI <br />