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Laboratories Inc. <br />Environmental Testing Laboratory Since 1949 <br />Chain of Celcfodv and Cooler Receipt Form for 1301612 Pacie 2 of 3 <br />BC LABORATORIES INC. COOLER RECEIPT FORM Rev. Me. l3 08117/12 Page O1 _ <br />1 <br />Submission #f: tSO l,? l- <br />SKIPPING INFORMATION <br />Federal Express D UPS ❑ Hand Delivery ❑ <br />BC Lab Field Service �4iP Other ❑ (Specify) <br />SHIPPING CONTAINER <br />Ice Chest a None ❑ <br />Box Ln Other O (Speciiy) <br />Refrigerant: Ice W Blue Ice ❑ None ❑ Other ❑ Comments: <br />Custody Seals <br />Ice Chest D <br />Containers❑ <br />None,'Or-'Comments: <br />All samples received? Ye3,2:;� No O All samples containers intact? Yes No ❑ Desariptionls) match COC? Yes�2n No ❑ <br />COC received <br />t YES NO <br />4``Ul1 --Thermometer i lX. dv� <br />Emissivity: Q \ 7 Container l <br />V <br />Temperature: [A) .t `C/l C )--L- •`� `C <br />Daterrime <br />Analyst Inir A <br />SAMPLE NUMBERS <br />SAMPLE CONTAINERS <br />7 2 3 A 5 6 7 H 4 le <br />OT GENERAL MINERAt1 GENERAL PHYSICAL <br />PT 12' UNPREWRIIIED <br />T INORGAN)C OW301CAL METALS <br />PT XNOAGAN)C CIM- WCAL METALS <br />PT CYANIDE <br />PT MITROGEN TORMS <br />PT TOTAL SULFIDE <br />I2oz NITRATE / WRITE <br />PT TOTAL ORGAN)C CARBON <br />PT TOX <br />PT OMUCAL OXYGEN DEMAND <br />PlA 39MNOIJCS <br />40mi VOA 11AL . TRAVEL BLAH <br />40-1 VOA VIAL C1 ':5 b 3, A 3 t <br />T EPA 413.3 411L 418.1 <br />PT ODOR <br />RADIOLOGICAL <br />BACTERIOLOGICAL <br />40 ail TDA VIAL -504 <br />T EPA 50BIGUARRI0 <br />T EPA S3SL8358 <br />T EPA 525 <br />T EPA SLS TRAVEL BLANK <br />109m] EPA 547 <br />10087 EPA 531.1 <br />T EPA 548 <br />T EPA 549 <br />T EPA 432 <br />T EPA 801 T4 <br />T AMBER <br />8 07 -JAR <br />32 02- JAR <br />SOA, SLEEVE <br />PCE VIAL <br />PLASnCEAC _ <br />FERROUS )RON <br />_ <br />ENCORE <br />SMART 107 <br />Comments: <br />Sample Numbering Completed By, LT Date/Time: '-Z 0 r <br />A = Actual 1 C = Corrected <br />The results in this report apply to the samples analyzed in accordance with the chain of custody document. This analvocal report must be reproduced in its entirety. <br />All results listed is 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 40 <br />0 <br />n <br />C <br />