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Laboratories Inc. 11 ' <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1209283 Page 3 of 4 <br /> BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev.No.12 06/24/08 Page C9 Of <br /> Submission#: <br /> SHIPPING INFORMATION SHIPPING,CONTAINER <br /> Federal Express ❑ UPS❑ Hand Delivery ❑ Ice Chest None ❑ <br /> BC Lab Field Service Other❑(Specify) Box ❑ Other ❑(Specify) <br /> Refrigerant: Icej< Blue Ice❑ None 0 Other❑ Comments: <br /> Custody Seals Ice Chest❑ Containers O None% Comments: <br /> lntact7Yes Nc <br /> In:tact?Yes'.O No <br /> All samples received? Yes No❑ All samples containers intact? Ye�No❑ f Description(s)match COC? Ye No ❑ <br /> COC Received Emissivity: 1/• T5 Container: bt'r Thermometer ID:_02 Date/Time�2- <br /> t YES ❑ NO Zl3f:< <br /> Temperature:A b "C / C LL- "C Analyst snit _ <br /> SAMPLE CONTAINERS 1 1 2 3 4 5 1 s 1 7 1 e 1 s 10 <br /> OT GENERAL MINERAL/GENERAL PHYSICAL <br /> FT PE UNPRESERVED <br /> T INORGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 2—NITRATE/NITRITE <br /> PT TOTAL ORGANIC CARBON <br /> PT TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> PtA PHENOLICS <br /> 40ml VOA VIAL TRAVEL BLANK <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 5081608/8080 <br /> T EPA 515.1/8150 r <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> 100.1 EPA 547 <br /> 100ml EPA 531.1 <br /> T EPA 548 <br /> T EPA 549 <br /> T EPA 632 <br /> T EPA 8015M <br /> T AMBER <br /> 8 02 JAR <br /> 32 OZ JAR <br /> SOIL SLEEVE <br /> PCO VIAL <br /> PLAMC BAG <br /> FERROUS IRON <br /> li <br /> ENCORE <br /> Comments: <br /> Sample Numbering Completed By: V.J Date/Time:S o� 35 <br /> A=Actual 1 C=Corrected i [N:toocsv POGILAB_DOcsFORMMAMRECzwrol <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.brlabs.com Page 5 of 70 <br />