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Laboratories, Inc. <br />Environmental Testing Laboratory Since 1949 <br />Chain of Custody and Cooler Receipt Form for 1201253 Page 2 of 2 <br />BC S INC. SAMPLE RECEIPT FORM Rev. Na. tz or>t2aroH Page _ i <br />--01263 <br />SHIPPING INFORMATION <br />❑ UPS D Hand Delivery ❑ <br />isI� Other D (Specify) <br />SHIPPING CONTAINER <br />{ce Chesl� None D <br />Box D Other D (Specify) <br />pO <br />Refrigerant: Ice Blue ice ❑ None ❑ Other ❑ Comments: <br />Custody Seals <br />Ice Chest ❑ <br />Intact? Yes O No <br />Containers ❑ <br />o <br />intact? Yes 0 N 10 <br />None Comments: <br />RIE samples received? Y599 No ❑ All samples containers intact? Yes o ❑ Description(s) match COC? Yes�o <br />COG Received Emissivit- <br />y: C� Container: ThermometerlD: 'ti DatelTme.1-��4� <br />��(ES ❑ NO ��11 c� 3 YDS <br />Temperature: A � +� `C 1 C d, J `C Analyst tnil �1U <br />SAMPLE NUMBERS <br />SAMPLE CONTAINERS t I 3 4 s s 7 e -10— <br />OT GENERAL MINERAU GENERAL PHYSICAL I7 <br />UNFRESERSrED <br />T INORGANIC CHEA11 CAL METALS <br />PT INORGANIC CHEMICAL METALS <br />PT CI'AM17DE <br />PT NITROGEN FORMS <br />PT TOTAL SULFIDE <br />2oz NITRATE /NITRITE <br />PT TOTAL ORGANIC CARBON <br />P7 TOa <br />PT CHEA9ICAL OXYGEN DEMAND <br />PtA PHENOLICS <br />40.1 VOA VIAL TRAVEL BLANK <br />FEAROlfS IRON <br />40.1 VOA VIAL 41.3 �J 1 1'31 t4 31 131 �1 `I t 1 i i <br />T ETA 413.1 ala 478.7 <br />FT ODOR <br />RADIOLOGICAL <br />.BACTERIOLOGICAL <br />40 u71 VOA \'IAL 504 <br />T EPA SD8/608JB080 <br />T EPA 515.I18I50 <br />T EPA 525 <br />T EPA S5 TRA\+EL B1ANK <br />IODmI EPA 547 <br />]ODmI EPA 531.1 <br />TEPA 548 <br />T EPA 549 <br />T EPA 632 <br />TEPA 8D15h1 <br />T AMBER <br />8 OZ JAR <br />32 OZ JAR <br />50lLSLEEVE <br />PCH VIAL <br />Comments: <br />Sample Numbering Completed Ely �(nir DatefTinve: <br />A = Actual l C = Corrected r :7D Pa04Ae_ODCS7FDRh15LSAMREC2WPD] <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 flys 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 Bakers <br />PLASTIC IIAC <br />FEAROlfS IRON <br />ENCORE <br />field, CA 93308 (661) 327-4911 FAX (661) 327-1918 www.bdabs.com Page 4 of 45 <br />