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Laboratories Inc. . Iib, <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1202496 Page 2 of 2 <br /> BC LAeORArCRIES INC. SAMPLE RECEIPT FORM Rev.Ain.12 oar2408 Pae Of_} <br /> Submission#' <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express ❑ UPS❑ Hand Delivery ❑ Ice Che-wc Nane 1:; <br /> BC Lab Field Serviced Other Cl(Specify) Box ❑ Other 0(Specify) <br /> Refrigerant: Ice Q, Blue lce❑ Nome❑ Other Q Comments: <br /> Custody Seals Ice Chest d-`l Containers❑ Wneg Comments: <br /> hnact7 ua No n lnract?Ym ❑ Nd-..n <br /> All Sarnples received? Ye'�' Non All samples containers kttact7 Y� No 0 bescripti�orgs)match COC?Ye'wj No <br /> COC Received Emissivity:_ Container:k Thermometer 10:-L t Datarrima (1 <br /> ?O-YES ❑NO v <br /> Temperature:A �- I C F C °G Analyst Init f <br /> SAMPLE CONTAINERS t 3 a 5 6 t B 9 t0 <br /> T GENERAL h11NERAU GENERAL PHYSICAL <br /> P'r rt(WrItESB:IFVEO <br /> OT INORGANIC C11 11CAL r,(ETAL.9 <br /> PT INUIt 'IC CHEMICAL NIPTALS <br /> .f'T t'YAMInF: <br /> I'1'NITiltoGEN,F4I141t7S <br /> FI'TCII"AL SULF[UF. <br /> laa NITIBATE IN l'i'lt <br /> 1"I"TOTAL rlltf;ANIC CA ItFIGN <br /> PT Ttlx <br /> F"1't:HEM1t/tIAL O!1°Clati DRAIAATI <br /> Pot PIrENOLIC.S <br /> 4I11111 VQA VGt TRA%IXL BLINK <br /> Mint VOA VIAL I I I <br /> TEPA 413.1,413A.4 L8J <br /> P I'DOOR <br /> R.1FJlflld GIC:\L <br /> RACI-ERInLOC ICA t. <br /> -011111 Y A VLAL-5#4 <br /> C'r LP' 5aa;6 'IHt1411 - <br /> T EVA Ki_118150 <br /> tri VIIIA 323 3 .. <br /> ',. Crr ETA 525 Y'1tUVl.HLA-11K. ! ~ <br /> Wind EPA 341 - <br /> W0m1 ITA 531.1 <br /> C T KPA 54S <br /> p'f F.F'a 5i4 <br /> FIT EPA 631 <br /> lr!'Ek'n dU1,64 <br /> 1 T:11IISF:IF <br /> B OI.I AR <br /> J2 UZA'%R <br /> 501L <br /> Pc•n v1Al. <br /> rI.ASTIC UAC <br /> FF"MOUS lit yq <br /> ENCORE f I <br /> Ontrn ants:_ ,_ft( �Y✓�� �� <br /> ample Nulnberirty COlnNotad Bye L�ateTeme: <br /> =Actual F C=Corroded �S�� �� ,fid " -2 r:yt+Vr�IRAa_nrn:aFcd+r,«a;nF,tREC:.w�Bl <br /> The results in this report apply to the samples analyzed in accordance with the chain of custody document.Thi.s analytical report must be reproduced in its entirety. <br /> All results listed in this report are for the exclusive use of the submitting party. BC Laboratories,Inc.assumes no responsibility for report alteration,separation,detachment or third party interpretation. <br /> 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.bclabs.com Page 4 of 12 <br />