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Laboratories Inc. <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1115933 Page 2 of 2 <br /> BC LABORATORIES INC. SAMPLE RECEIPT FORM :. Np.12 0412+x,8 Page f O7 y _ <br /> Submission w: 7 — , I <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express O UPS O Hand Delivery Q Ice Chest None O <br /> £C Lab Field Service Other O fSpectry)^,___ Boz :.s Other 0(Specify} <br /> Refrl Brant: Ice❑ Blue Ice❑ NonaOther F1 Comments: <br /> j <br /> Custody Seals Ice Chant❑ CoMainars❑ None Comments: <br /> 1 7Y o No <br /> Alf s.mplos oncalred9 Y Hoa All sompkz corvtaMera inlaee7 Y.5,KNor' OeseNptlaMsl lRalch CCC7 Yrsd No❑ <br /> OC Received " ^tf"� <br /> ErnlssWlty: �--- Container: TRcimomolor 10:— Fm, Oe1clTimR n-�1'I <br /> YES ❑NO C IcIt-(U <br /> 4empefalwc:A �t1(?!.'t -C / C L� •C Analyst Inst 51�.11A) <br /> I <br /> SAMPLE CONTAINERS <br /> EN RAL"ERAL1 GENERAL PHYSICAL <br /> PT PE BI:pRFMEAVEP <br /> 'r IMIRCANIC CHEMICAL b1ETAIS <br /> PTtMJRGAN{ .N 1lf 1.MFT414 <br /> PT NITROGi.M <br /> VTTMAL51 <br /> 3nc NfYRATE/NI RE 1 <br /> Pr T(YI'AL IMIGAHIC CARe[IN <br /> x <br /> 11E}IIGLOSYCFN e¢MANa <br /> y <br /> 1Dnt 1-06\' If <br /> i1 J VOA VIAJI 1 1 I 1 1 1 1 1 11 <br /> T EPA 4113 4131 <br /> PTOMR <br /> RAnlOW ICAI <br /> 9AC'rEA1f1WCf <br /> 10 ml SDA YtAI.5R4 <br /> OT erA se3.05MIRIM <br /> DJUA IAISU <br /> P]'A 515 <br /> r.YA S:S TRA\T {' <br /> 10.1 EPA W9 <br /> NOW EPA 511.1 <br /> 1EPA <br /> 0 EPA}9 <br /> AM+ <br /> ern w15M <br /> T AMBP <br /> a oEl <br /> 3'07.JAR <br /> SLEEVE <br /> r <br /> ILAE11C RAC <br /> "AR -j QN <br /> ENURE <br /> Cammenla' <br /> S.mpk,Nomhedng ConmrnI.d lou: 0p ` <br /> A=Actoal 1 C=C ,,xJ+d lrto/iime':= F5�5- <br /> (if:'uiIC3NIPU'.1U.a OOGScaav511aWtg4L1YF9j <br /> ]lM rend/In in this repan apply m rhe rcdmpyfn a sulyzed in an, BCnue wtre rho 1. fcdsraldy dwmmenr y'his nrt nl..l rflwn muse a reproduced,d irn,unm <br /> All suits listed in Nis reyon are fm the e.clusive one ofthe subminins P.rtY. BC L.bontoliq Ilse.llv mepmrsibility fm report eltmuon,sepantim,deuchment or tM1ird grry imsmrelabod <br /> 4100 Atlas Court Bakersfield,CA 93308 (661)3274911 eFAX(661)327-1918 w .bdabs.com page 4 or 10 <br />