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M�Laboratories Inc. <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1621370 Page 2 of 2 <br /> BC LABORATORIES INC. COOLER RECEIPT FORM Page Of <br /> Submission#: ' <br /> SHIPPING INFORMATION SHIPPING CONTAINER FREE LIQUID <br /> Fed Ex ❑ UPS❑ Ontrac❑ Hand Delivery ❑ Ice Chest� None ❑ Box ❑ -YES, NO ❑ <br /> BC Lab Field Service Other❑(Specify) Other ❑(Specify)_ $ <br /> Refrigerant: Ice Blue Ice❑ None❑ Other❑ Comments: <br /> Custody Seals Ice Chest❑ GtntamefsO., None)/ Comments: <br /> All samples received? Yes No❑ All samples containers intact? Yes K No❑ Description(s)match COC? Yes No O <br /> \\�COG Received Emissivlty:I / Contaiinner: Thermometer ID: < DatelTlm0r�&9 <br /> IVYES ❑ NOTemperature: (A) l 'C ! 1 C °C Analyst Init G <br /> SAMPLE NUMBERS <br /> SAMPLE CONTAINERS7 8 9 10 <br /> 1 2 3 4 5 5 <br /> T PE UNPRES <br /> 4oz/8oz/16oz PEUNPRES <br /> 2oz Cri6 <br /> I <br /> T INORGANIC CHEMICAL METALS 1 <br /> INORGANIC CHEMICAL METALS 4oz/Soz!16oz <br /> i <br /> PT CYANIDE I <br /> PT NITROGEN FORMS i <br /> PT TOTAL SULFIDE <br /> 2oz.NITRATE/NITRITE <br /> PT TOTAL ORGANIC CARBON <br /> PT CHEMICAL OXYGEN DEMAND <br /> PLA PHENOLICS <br /> 40ml VOA VIAL TRAVEL BLANK i <br /> 40m)VOA VIAL (`-� 1 <br /> T EPA 1664 <br /> PT ODOR <br /> RADIOLOGICAL <br /> I <br /> BACTERIOLOGICAL <br /> 40 ad VOA VIAL-504 <br /> T EPA 508/608/8080 <br /> T EPA 515.1/8150 i <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK j <br /> 40m1 EPA 547 <br /> 40ml EPA 531.1 <br /> 8oz EPA 548 I <br /> T EPA 549 <br /> QT EPA 8015M <br /> T EPA 8270 <br /> 8oz I16oz/32oz AMBER <br /> Roz/16oz/32oz JAR <br /> SOIL SLEEVE <br /> PCB VIAL <br /> PLASTIC BAG j <br /> TEDLAR BAG I <br /> FERROUS IRON <br /> ENCORE <br /> SMART KIT <br /> i <br /> I <br /> SUMMA CANISTER i <br /> Comments: <br /> Samole Numbering Comoleted By: DatelTime• aav 2t o5l231zots <br /> The results in this report apply to the samples analyzed in accordance with the chain ojcustody 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 /> Report ID: 1000513601 4100 AUas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.bciabs.com Page 4 of 29 <br />