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H <br />Laboratories Inc. I, od <br />Environmental Testing Laboratory Since 1949 <br />Chain of Custody and Cooler Receipt Form for 13zzzyts rage s OT.5 <br />3C LABORATORIES INC. COOLER RECEIPT FORM No. 16 07101113 Page _ Of _ <br />Submission : M - Q-79 S <br />SHIPPING INFORMATION SHIPPING CONTAINER IFFREE LICIUID <br />'ederal Express ❑ 'UPS ❑ Hand Delivery Ice Chest t-' None ❑ Box ❑❑ NO ❑ <br />3C Lab Field Service i(! Other ❑ (Specify! Other ❑ (Specify) <br />Refrigerant: lce Blue Ice ❑ None ❑ Other ❑ Comments: <br />:ustody Seals ;Ice Chest L3 Catamers❑; None Comments: <br />aB samples received? Yes No.O All samples containers intact? Yes d—No ❑ Description(sl match CDC? Y-401({No ❑ <br />COC Received =EmissivitY:C-)!�Container_Thermometer IDt Date/Tmei 1(�IES ❑ NO CAnalyst Init r "C 1 (C I _ <br />X <br />SAMPLE NUMBERS <br />132 <br />SOIL SLEEVE <br />PCEI VLiL <br />PI..ASTIC BAG <br />FERILOUS IRON <br />ENCORE I <br />SNIART 107 <br />Struinni Canister <br />omments: <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. asstimes 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.bciabs.com Page 5 of 58 <br />