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Laboratories Inc. <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1205559 Page 2 of 2 <br /> BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev.No.12 06/24109 Page Of <br /> Submission#: <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express ❑ C❑ Hand Delivery ❑ Ice Chest None ❑__ _ <br /> BC Lab Field Service other O(Specify) Box ❑ Other ❑(Specify) <br /> Refrigerant: I cejV Blue Ice❑ None c Other❑ Comments: <br /> Custody Seals ice Guest p Cor(Yainers Q None O. Comments: <br /> intact-7 Yes -No J intact?.Yes Na <br /> All samples received? Ye No O All samples containers Intact? Yes i-No D Description(s)match COC? Yesi7 No <br /> COC Received Emissivlty: AQ Container: ,� Thermometer ID: M_ Date/Tme -J R [Z. <br /> YES ❑ NQ <br /> Temperature: ,- °C ! C , ^C Analyst lnit_ a310 <br /> SAMPLE CONTAINERSt 2 7 4 5 s 7 5 5 10 <br /> OT GENERAL MINERAL/GENERAL PHYSICAL <br /> PT PE UNPMERVED <br /> T INORGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 2m.NITRATE/NITRITE <br /> PT TOTAL ORGANIC CARBON <br /> PT JQX <br /> PT CHEMICAL OXYGEN DEMAND <br /> to PHENOLICS <br /> 40ml VOA VIAL TRAVEL BLANK 2q <br /> 40ml VOA VIAL r J t 1 1 1 t t I I 1 I 1 t I I I I <br /> T EPA 417.1 40. 418.1 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 ml VOA VIAI,504 <br /> T EPA 508/608/8080 <br /> T EPA 515.119150 <br /> T EPA 515 <br /> T EPA 515 TRAVEL BLANK <br /> 100m1 EPA 547 <br /> 100m1 EPA MIA <br /> T EPA 548 <br /> T EPA 549 <br /> QT EPA 632 <br /> T EPA 8015M <br /> T AMBER <br /> 8 OZ JAR <br /> 72 02.JAR <br /> OIL SLEEVE <br /> PCB VIAL <br /> PLASTIC BAG <br /> PERILOUS IRON <br /> ENCORE <br /> omments• <br /> ample Numbering Completed By; G 1 W 0atemme: U <br /> =Actual t C=Corrected (�t;,S [M:100CStWPe01LA9 DOCSIFORI4SISAMREC2.WPeI <br /> The results in this report apply to the samples analyzed in accordance with the chain of custody document. This 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 alterationj 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 14 <br />