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Laboratories Inc. <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1511590 Page 2 of 2 <br /> BC LABORATORIES INC. COOLER RECEIPT FORM Rev.No.16 09/04/14 Page Of <br /> Submission#: —►igto <br /> SHIPPING INFORMATION SHIPPING CONTAINER FREE LIQUID <br /> Federal Express ❑ UPS❑ Hand Delivery ❑ Ice Chest❑ None ❑ Box YES ❑ NO ❑ <br /> BC Lab Field Service K Other❑(Specify) Other ❑(Specify) <br /> Refrigerant: Ice❑ Blue Ice❑ None 0 Other❑ Comments: <br /> Custody Seals Ice Chest❑ Containers❑ None% Comments: <br /> All samples received? Yes I$, No❑ All samples containers intact? Yes g—. No❑ Description(s)match COC? Yes OR, No ❑ <br /> COC Received Emissivity: t®t L� Contains Thermometer ID:�` Date/Time I�I� <br /> Z35 <br /> YES ❑ N® Tem erature: 1 A) `i °C l (C 1 Z °C Analyst Inst <br /> SAMPLE NUMBERS <br /> SAMPLE CONTAINERSt 2 3 a s s 7 s 9 t0 <br /> T GENERAL MINERAIJ GENERAL <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 /> 2.NITRATE l NITRITE <br /> PT TOTAL ORGANIC CARBON <br /> Ply TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> PtA PHENOLICS. <br /> 40m1 VOA VIAL TRAVEL BLANK <br /> 40mi VOA VIAL <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 508160819080 <br /> T EPA 515.18150 <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> 40rn1 EPA 547 <br /> 40m1 EPA 531.1 <br /> sea Amber 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 /> SMART KIT <br /> Summit Canister <br /> Comments: <br /> Sample Numbering Completed By: _ Date/Time: `-' IS:1WPDoclWardPerlect\LAB DOCMFORM%SAMRECI <br /> A=Actual ! C = Corrected <br /> The results in this report apply to the samples analyzed in accordance with the chain of custody document.This analytical report must he reproduced in its entirety. <br /> All results listed in this report are for the exclusive use of the submitting parry. BC Laboratories,Inc.assumes no responsibility for report alteration,separation,detachment or third party interpretation. <br /> Report ID: 1000356123 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.bclabs.com Page 4 of 16 <br />