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Laboratories Inc. <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1400932 Page 3 of 3 <br /> BC LABORATORIES INC. COOLER RECEIPT FORM Rev.No.15 o7loln3 Page 2 Of 2 <br /> Submission#: j q - n� Z <br /> SHIPPING INFORMATION SHIPPING CONTAINER FREE LIQUID <br /> Federal Express ❑ UPS❑ Hand Delivery Ice Chest None ❑ Box ❑ YES ❑ NO ❑ <br /> BC Lab Field Service Other❑(Specify) Other ❑(Specify) <br /> 44 <br /> Refrigerant: Ice Blue Ice❑ None❑ Other❑ Comments: <br /> Custody Seals Ice Chest❑ Coittamers'� None Comments: <br /> 7_. <br /> AU samples received? Yes A- No O All samples containers intact? Yes No❑ Description(s)match COC? Ye No ❑ <br /> OZrD <br /> C Received Emisstvky: 9,5 container. � Thermometer ID: I� Date�mel �¢ / <br /> ES NO Temperature: (A)JCC / i C ) _ oC Analyst Ink_ <br /> SAMPLE NUMBERS <br /> SAMPLE CONTAINERS 2 3 a 6 b 7 a 9 70 <br /> QT GENERAL MINERAV GENERAL <br /> rr PE I)HPRE,SERVED <br /> T INORGANIC CEDUCAL METALS <br /> PT II40RGANIC CJiB[.2ICAL METALS <br /> PT CYANIDE <br /> Pr NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 2oa NITRATE/NITRITE <br /> Pr TOTAL ORGANIC CARBON <br /> Pr TOS <br /> Pf Cl>ZUMICAL OXYGEN DEMAND <br /> PlA PHENOLICS <br /> 40"VOA VIAL TRAVEL.BLANK tZ� <br /> 40niVOAVIAL <br /> EPA 413.L 4L3.2,41&1 <br /> Pr ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 int VOA VIAL SO4 <br /> T EPA S08t60&808s <br /> QT EPASll-, tar <br /> OT EPA 525 <br /> -._ - <br /> gr EPA 525 TRAVEL BLANK ------ '------- -.. <br /> 100mt EPA 547 <br /> I00ml EPA SiL1 <br /> Crr EPA 548 <br /> EPA 549 <br /> QT EPA 632 <br /> T EPA 8015M <br /> AMBER <br /> 8 OZ JAR <br /> 32 OZ JAR <br /> SOIL SLEEVE <br /> PCB VIAL <br /> PLASTICBAG <br /> FERROt)S IRON <br /> ENCORE <br /> SMART KTP <br /> Summa Catrister <br /> Comments: <br /> Sample Numbering Completed By: Date/Tirne: <br /> iS:v <br /> A= Actual I C= Corrected t,yootsiWorsmertecr oOcsiFoaM9tsaNuiECtsl <br /> The results in this report apply to the samples analyzed in accordance with the chain of custody document This ana4lica/report must be reproduced in its entirety. <br /> All results listed m this report are for the exclusive use of the submitting parry. BC Laboratories,Inc.assumes no responsibility for report alien tom separation,detachment or third party interpretation. <br /> 4100 AUas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.bciabs.com Page 5 of 59 <br />