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Laboratories Inc. <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1200464 Page 2 of 2 <br /> BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev_No.12 D6124108 Page Of _ <br /> Submission ff• /-P '-COr F(DYf <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express ❑ UPS❑ Mand Delivery ❑ Ice Chest None ❑ <br /> SC Lab Field Service Other❑(Specify) Box ❑ Other ❑(Specify) <br /> ------------------------- <br /> Refrigerant: Ice 1, Blue Ice❑ None❑ Other❑ Comments: <br /> Custody Seals iceeChest❑ Containbrs4qTO' None�Cs�'Comments: <br /> Intacl2'Ye�❑ No❑ lntaa.l.-Yes,O!No; <br /> All samples received? Yes No D All samples containers Intact? Yes No❑ Description(s)match COC? yes .No ❑ <br /> CDC Received Emissivity: 2, .` Container: Thermometer ID: k-1-1 C_ <br /> Daterrime1 J {1 <br /> ,P YES ❑ NO •� <br /> Temperature:A LI' ^C 1 C (`..�_B C Analyst Init i vvJ <br /> _........__.._SAMPLE-CONTAINERS._... -----_---,----. <br /> 1 2 3 4 5 6 T a 9 10 <br /> OT GENERAL MINERAL/GENERAL PHYSICAL <br /> PT PE UNPRF:SER VED <br /> T INORGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS L Cr <br /> PT CYANIDE <br /> PT NITROCEN FORA-IS <br /> PT TOIAL SULFIDE <br /> 2uz NITWtTE INITRJTE <br /> PT TOTAL ORGANIC CARBON <br /> PT TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> PLA PIIENOLICS <br /> 40ml VOA URAL TRA VEL BLANK <br /> 40m1 VOA VIAL 4.5 f}-r3 L fj— <br /> T EPA 413.1.413.2.418.1 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 ml VOA V1AL•504 <br /> T EPA 508160818080 <br /> T EPA 515.1/8150 <br /> OT EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> 100-1 Et'A 547 <br /> 100-1 EPA 531.1 <br /> CIT EPA 548 <br /> T EPA 549 <br /> T EPA 632 <br /> T EPA 8015M <br /> OT AMBER <br /> B 07-1 R <br /> 32 07-JAR <br /> SOIL SLEEVE <br /> PCB VIAL <br /> rLASTIC DAG <br /> FERROUS FRON <br /> ENCORE <br /> :ommenLs: <br /> Sample 1411mbenng Completed By: Datelrime: <br /> A=Actual I C=Corrected ^^'' IH:iDDC 51WYpeLLAe DOCSIriJRU15l5A MRE C?wnOl <br /> �V a <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 parry.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 26 <br />