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[1 <br />Ci <br />u <br />11 <br />h <br />0 <br />0 <br />P <br />u <br />0 <br />— <br />Laborat�:L�a2boretWor�y�Sinfel.; <br />Environmental Test949 <br />Chain of Custody and Cooler Receipt Form for 1117340 Page 2 of 2 <br />BC LABORATORIES INC. �7 SAMPLE RECEIPT FORM Rev. No. 12 06124/08 Page _Lf <br />Submission #: l — ( T <br />SHIPPING INFORMATION <br />Federal Express ❑ UPS ❑ Hand Delivery 13Ice <br />BC Lab Field Service 0' Other ❑ (Specify) <br />SHIPPING CONTAINER <br />Chest None ❑ <br />Box ❑ Other ❑ (Specify) <br />Refrigerant: Ice if Blue Ice ❑ None ❑ Other ❑ Comments: <br />Custody Seals Ice Chest ❑ 1 =Cwtai.nners ❑ Nonee Comments: <br />intact? as No O No <br />All samples received? Y o ❑ All samples containers intact? No ClDescription(s) match COC? Ye o C] <br />COC Received Emissivity: 0'q Container: �(C_ Thermometer ID: Date/Time W -\q-11 <br />YES 0 NO Temperature: A .°C I C 0.9 °C Analyst [nit ,tiauJ <br />SAMPLE CONTAINERS t 2 3 4 5 a 7 a s to <br />OT GENERAL MINERALI GENERAL PHYSICAL <br />PT PE UNPRESERVED <br />T INORGANIC CHEMICAL METALS <br />PT INORGANIC CHEMICAL METALS <br />PT CYANIDE <br />PT NITROGEN FORMS <br />PT TOTAL SULFIDE <br />z- NITRATE / NITRITE <br />PT TOTAL ORGANIC CARBON <br />PT TOX <br />PT CHEMICAL OXYGEN DEMAND <br />PtA PHENOLICS <br />40.1 VOA VIAL TRAVEL BLANK <br />l 1 1 1 I 1 1 I 1 1 I ( 1 f l 1 <br />40.1 VOA VIAL <br />T EPA 413.1 413.2 418.1 <br />PT ODOR <br />RADIOLOGICAL <br />BACTERIOLOGICAL <br />40 ml VOA VIAL 504 <br />T EPA 508/608/8080 <br />T EPA 515.1/6150 <br />T EPA 525 <br />T EPA 525 TRAVEL BLANK <br />100ml EPA 547 <br />100.1 EPA 531.1 <br />T EPA 548 <br />T EPA 549 <br />T EPA 632 <br />T EPA 8015M <br />T AMBER <br />8 OZ JAR <br />32 OZ JAR <br />SOILSLEEVE <br />PCB VIAL <br />PLASTIC BAG <br />FERROUS rRON <br />ENCORE <br />Sample Numbering Completed ey: Date/Time: <br />A - Actual / C = CorrectedIH:\DOCS1WPa01LAS_DOCS%rORMS1SAMREC2.WPOI <br />The results in this report apply to the samples analyzed in accordance with the chain of custody document. This analytical report must he reproduced in its entirety. <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 14 <br />