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Laboratories Inc. �d <br /> anEnvironmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1717170 Page 2 of 2 <br /> Be <br /> ATORIES INC. COOLER R CEIPT FORM PaeJ.Of <br /> on#: <br /> SHIPPING INFORMATION SHIPPING CONTAINER FREE LIQUID <br /> UPS❑ Orltrac❑ Hand Delivery ❑ Ice Chest 8 None ❑ Box ❑ YES ❑ NO ❑ <br /> id Service Ill Other❑(Specify) Other ❑(Specdfy) W S <br /> t: fee!S Blue Ice❑ None® Other❑ Comments: <br /> eals ' G l7..s. ''.Na."i 0'Eh None IN Comments: <br /> received? Yes No O All samples containers intact? Yes NoO Descriptions►match COC? Yesig No O <br /> COC Received EmiWitky: ' Container �Ma Thermometer ID:�� Dateirille <br /> ®YES ❑NO Temperature: I A I •C t C ^c f Anal as kilt <br /> SAMPLE NUMBERS <br /> SAU!PRFS <br /> QTFEWRIS <br /> 4oz/8oz/16oz PR <br /> T CIv 3Y :'ii _. <br /> 2MRG CBEoz <br /> PT F <br /> PT <br /> 2oz. U1NCPRITB <br /> -------- <br /> PrZOTALORGAMCC&MON <br /> PT CREMICAL DEKOW <br /> PIA PWINOYACS <br /> 40�VOAVIALTTtAVBLBLANK <br /> 40m1 VOA VIAL <br /> T RPA 1664 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 mi VOA VIAL 504 <br /> EPA 80 <br /> SPASIS.U8150 .�. .. <br /> gj BPA 52S <br /> Or BTA US TRAVEL BLANK <br /> 401W EPA S47 <br /> 40mI EPAMLI <br /> Boz BPA S48 I <br /> gj BPA 50 <br /> QT EPA 80L%f <br /> OT EPA 8170 <br /> 9tn:/16sz/32m AMBER <br /> 8oz/16qZ132uJAR <br /> son.gimn <br /> PLASTIC AG <br /> i <br /> TEDLARBAG <br /> 'FBRROUSIRON <br /> ENCORE <br /> SMART Krr <br /> SUMMA CANISTER <br /> :omments• <br /> ;ample Numbering Completed By: Date/Tkne: Ilav 21 05=112016 <br /> 0 t=Actual / C=Corrected tsawroodw«ararKawe_ 20 <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 alteration,separation,detachment or third party interpretation. <br /> Report ID: 1000620712 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.bclabs.com Page 4 of 12 <br />