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Laboratories Inc.—JjtUl, <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1200583 Page 2 of 2 <br /> 3C LABORATORIES INC. SAMPLE RECEIPT FORM Rev_No.12 06124/08 Page L Of <br /> Submission#t:G <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> =ederal Express ❑ UPS O Hand Delivery ❑ Ice Chesv;rl None ❑ <br /> 3C Lab Field Service Other❑(Specify) Bax ❑ Other ❑(Specify) <br /> Refrigerant: IceG51� Blue Ice❑ None❑ Other❑ Comments: <br /> :ustody Seals IIce'Chest O E- None& Comments: <br /> Infeetl Ye3 0 Na 61Inlatt;'`Year.��`Nu>� <br /> .11 samples received? Yes 0""No O All samples conttaiiner$Intact? Yes Z No❑ Description(s)match COC? Yes 0'No 0 <br /> COC Received Emissivity: -n,8 Container:� Thermometer ID:�� <br /> LYES ❑ NO Daterrime <br /> O zzzo <br /> Temperature:A °C / C `C Analyst tnil <br /> SAMPLE CONTAINERS <br /> t x � 4 6 fi 7 e s to <br /> T GENERAL MINERAL!GENERAL PHYSICAL <br /> T PE tB�PRESERVED �.. <br /> T INORGANIC CHEMICAL METALSp <br /> T INORGANIC CHEMICALMETALS b CIO D <br /> T CYANIDE <br /> T NITROGEN FORMS t <br /> T TOTAL SULFIDE <br /> NITRATE 1 NITRITE <br /> Y TOTAL ORGANIC C "ON <br /> r TOX <br /> T CHEMICAL OXYGEN DEMAND <br /> to PHENOLICS <br /> Intl VOA VIALTRAVEL BLANK TE- <br /> lint VOA VIAL 13 1� I 1 { !3 131 t 1 1 I 1 1 t 1 1 <br /> T EPA 013.] 413.2 418.1 <br /> rODOR <br /> ADIOLOCICAL <br /> ACTERIOLOGICAL <br /> 1 ml VOA VIAL 504 <br /> T EPA 508160818080 <br /> T EPA 515.118150 <br /> T EPA 525 <br /> T EPA 525 TT1AVEL BLANK <br /> 10mi EPA 547 <br /> Wml EPA$3I.1 <br /> T EPA 548 <br /> T EPA 549 <br /> T EPA 632 <br /> r EPA 8015M <br /> r AMBER <br /> O2.JAR <br /> II SLEEVE <br /> :B VIAL <br /> ,AMC BAG <br /> :RROUS IRON <br /> ')CORE <br /> mments: <br /> nple Numbering Completed By: DatelTime: <br /> Actual 1 C=Cortecled (HaD0CS1WP001LAB D0CSIF0RMS%SAMREC2.wPDi <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 entirely. <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 40 <br />