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C <br />Environmental Testing Laboratory Since 1949 <br />Chain of Custody and Cooler Receipt Form for 1609171 Paae 2 of 2 <br />BC LABORATORIES INC. <br />COOLER RECEIPT FORM <br />Page Of <br />Submission <br />SHIPPING INFORMATION <br />Fed Ex ❑ UPS ❑ Ontrac ❑ Hand Delivery ❑ <br />BC Lab Field Service Other ❑ (Specify) <br />SHIPPING CONTAINER <br />Ice Chest None ❑ Box ❑ <br />Other ❑ (Specify) <br />FREE LIQUID <br />YES ❑ NO ❑ <br />Refrigerant: Ice Blue Ice ❑ None ❑ <br />Other ❑ Comments: <br />Custody SealsIce <br />Chest ❑ <br />Cor4talnt rs.❑ <br />None I� Comments: <br />," <br />All samples received? Yes No ❑ All samples containers intact? Yes No ❑ Description(s) match COC? Yes No ❑ <br />COC Received Emissivity: _ ,C7 S <br />YES ❑ IVO Temperature: I A) <br />Container: `L Thermometer ID: 2O� <br />°C ! (C ) °C <br />Date/Time• 3o,lc9 dry fh <br />Analyst [nit Gl/ lh <br />SAMPLE CONTAINERS <br />1 2 <br />SAMPLE NUMBERS <br />4 6 6 7 <br />B 9 10 <br />T PE UNPRES <br />4oz / 8oz / 16oz PE UNPRES <br />2oz Cr" <br />T INORGANIC CHEMICAL METALS <br />INORGANIC CHEMICAL METALS 4oz ( Buz / 160z <br />PT CYANIDE <br />PT NITROGEN FORMS <br />PT TOTAL SULFIDE <br />2oz NITRATE / NITRITE <br />PT TOTAL ORGANIC CARBON <br />PT CHEMICAL OXYGEN DEMAND <br />- <br />PIA PHENOLICS <br />40ml VOA VIAL TRAVEL BLANK <br />40mi VOA VIAL <br />T EPA 1664 <br />PT ODOR <br />RADIOLOGICAL <br />BACTERIOLOGICAL <br />40 ml VOA VIAL- 504 <br />T EPA 508/608/8080 <br />T EPA 515.118150 <br />T EPA 525 <br />T EPA 525 TRAVEL BLANK <br />10ml EPA 547 <br />S0m1 EPA 53L1 <br />ioz EPA 548 <br />T EPA 549 <br />T EPA 801sM <br />T EPA 8270 <br />'oz / 16oz / 32oz AMBER <br />;oz / 16oz / 32oz JAR <br />SOIL SLEEVE <br />'CB VIAL <br />'LASTIC BAG <br />'EDLAR BAG <br />FERROUS IRON <br />:NCORE <br />WART KIT <br />!UMMA CANISTER <br />rmments: <br />ample Numbering Completed By: <br />= Actual / C =Corrected <br />Date/Tim <br />[S:1W➢--IWordPerractlLAa <br />Rev 20 07/24/2015 <br />OOCS%FORMMSAMREC,ev 201 <br />The resuhs 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: 1000471313 4100 Atlas Court Bakersfield, CA 93308 (661) 327-4911 FAX (661) 327-1918 www.bclabs.com Page 4 of 29 <br />