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Laboratories Inc. I . <br /> Environmental Testing Laboratory Since 1949 <br /> ® Chain of Custody and Cooler Receipt Form for 1213026 Page 3 of 3 <br /> BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev.No.12 (16174106 Page Of <br /> Submission #: I a-13D�(D <br /> SHIPPING INFORMATION <br /> SHIPPING.CONTAINER <br /> Federal Express ❑ UPS❑ Hand Delivery O Ice Chest' None ❑ <br /> HG Lab Field Service Other❑(Specify) Box Q Other ❑(Specify) I <br /> Refrigerant: Ice PD Blue Ice❑ None D Other❑ Comments: <br /> Custody SealsIce Chest❑ C retainers❑ NoneV Comments: <br /> Entact7 Yes No IrifaclTYes D No ❑ <br /> All samples received? Yes 1400 All samples containers intact? Yes e. No❑ Description(s)match COC? Yesff No p <br /> COC Received Emissivity; 0."1 F�_ Container: Thermometer 1–I <br /> 1'E = — DatelTime 1–ILs–(��D <br /> S 0 ❑ NO <br /> Temperature:A t,Z "C l C ,, j 'C Analyst Init J€iltij a <br /> SAMPLE CONTAINERS 7 w ] <br /> OT GENERAL MINEF2ALIGENERAL PHYSICAL 10 <br /> [IT PE UNPRESERVED <br /> QT ENORGANIC CHEMICAL METALS <br /> P-r 1N0RCA,NtCCI1LMtCALa4ETAES <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 10,NITRATE/NITRITE <br /> T"r TOTAL ORGANIC CARBON <br /> PT TOX <br /> PT CHEMICAL OS'YCEN nESLAND <br /> PIA PIIENOLIC$ <br /> 1p 40m1 VOA VIAL TRAVEL BLANK <br /> 70mt VOA VIAL 1 1 1 ( 1 1 1 1 I 1 1 1 I I 1 <br /> I I <br /> 1'r EPA 413,1.411,2,4 16.1 _ - <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 1-11 VOA VIA t.illi <br /> QT EPA 508/6 081666 6 <br /> 7 EPA 515.1/6150 <br /> T EPA 525 <br /> IT-EPe1 i�"T[tA VEL BLANK . <br /> IDOmI EPA 547 <br /> 100m1 EPA 511.1 <br /> iT EPA 546 <br /> T EPA 549 <br /> 2T EPA 611 ` <br /> l7 EPA 601 iAd <br /> 17.AJ11 R ER <br /> OZ JAIL <br /> JAR <br /> SOI L SLEEVE <br /> 'CO VIAL <br /> 'LA.STIC 6.{G <br /> 'ERROIIS IRON <br /> :NCORE 1h I <br /> �mrnents: <br /> ImPln Numbering Completed By: i k 0 DatelTime:t <br /> =-Actual ! C=Corrected pilD0eS1wP8ulCA8i:D0CS1FDRMSI5A11neczweDl <br /> • <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 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 5 of 58 <br />