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Laboratories Inc. <br />Environmental Testing Laboratory Since 1949 <br />Chain of Custodv and Cooler Receipt Form for 1301611 Pape 2 of 2 <br />BC LABORATORIES INC. <br />COOLER RECEIPT FORM Rev. No- 13 0811712 rage ut j <br />Submis=-ion y• <br />SHIPPING INFORMATION <br />Federal Express ❑ PS ❑ Hand Delivery ❑ <br />BC Lab Field Service Other ❑ (Specily) <br />SHIPPING CONTAINER <br />Ice ChesI None ❑ <br />Box ❑ Other ❑ ISpeciiyy <br />Relrigerant: Ice Blue Ice ❑ None ❑ Other O Comments: <br />Custody Seals <br />Ice Chest ❑ <br />7 <br />Containers ❑ <br />L <br />None�2 Comments: <br />All samples received? Yes,[ % No D <br />AN samples containers imact? Yes Y�` No ❑ Deseriptionls) match CDC? Yes P -No C1 <br />COC Received <br />,CDC <br />❑ NO <br />Emissivity: <br />J Container Thermomeler ID: AQ� Daie/Timet 3-I?�'. 0 <br />U� <br />Temperature: (A 1 i ( C 1 1 C I Lit `I 'C Analyst Snit JtJO <br />SAMPLE CONTAINERS <br />SAMPLE NUMBERS <br />1 2 1 q 5 6 7 8 9 10 <br />OT GENERAL MINERAL) GENERAL PHYSICAL <br />jY PEUXPRESERVED %O -Z- <br />L C r <br />T INORGANIC CHEMICAL METALS <br />PT WORGANl C CHEMICAL MSrALS <br />{ <br />G t F— <br />PT CYANOIE <br />" <br />A <br />PT NmtOGEN FORMS <br />F F <br />PT TosAL SULMDE <br />Ua- m1ATE t NTTILr <br />tt <br />PT 4OTAL ORGANIC CARIION <br />PT TOX <br />PT C1041CAL OXYGEN DEMAND <br />Pal PIIENOLIC-S <br />40-1 VOA VIAL TRAVEL BLANK <br />lI <br />i <br />40-1 VOA VIAL <br />T L•PA 413.1 4132- 419.1 <br />1'T ODOR <br />RADIOLOGICAL <br />BA CTEIUDLOCICAL <br />40 -t VOA V LAI, 594 <br />T EPA 5981ro 11080 <br />T EPA 51L7/8159 <br />f <br />OT EPA 525 <br />OT EPA 525 TRAVEL DLANIC <br />100-1 EPA 547 <br />100ml EPA 531-1 <br />T EPA 548 <br />T EPA 549 <br />T EPA b72 <br />T EPA Piss <br />T AMBER <br />S 07 -AR <br />.l2 OL JAR <br />SOD -SLEEVE <br />, <br />PCE V1AL <br />PLASTIC H A G <br />FERROUS IRON <br />ENCORE <br />SN UUiT HJT <br />Comments: <br />S>-,.1., p�:•.•-:6a':'_ C_mple¢gi By: <br />A = Actual I C Corrected <br />Dal=_fTme: �Z 6 <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.bdabs.com Page 4 of 26 <br />C� <br />C <br />C <br />