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:M Laboratories Inc. <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1905437 Page 2 of 2 <br /> 8C LAB0RATIRIES INC. COOLER RECEIPT' FORM Page � Of <br /> Submission # t <br /> SHIPPING INFORMATION SHIPPING CONTAINVIZ FREE LIQUID <br /> Fed Ex ❑ UPS D Qntrnc q Nand Delivery' Icp Chest ❑ No Box D YES ❑ Pf0 D <br /> f3C Lab Field Service ❑ Other ❑ (Specify) OthCr - S Ir.[wry ,__ <br /> AT <br /> Refrigerant: Ice Blue ice None 1=i Otiier ❑ Comments: <br /> Custody $eils !ce CIIf st Ci �Ittait arc ❑ Ntrnc'�Commcntst <br /> Itt�1 sp 4b 4 <br /> 1L31 <br /> AD sat"foo teoNl+oud? Yas No ❑ Ad 4nirnplos containers Intact? Yea NO ❑ Ouumipiionts) matotl C700? YRt No ❑ <br /> ... . COC Rooe'Ved Ern)Salvlty: &5 containerrS' fiermomotorID: <br /> nOc <br /> Datallilrt1a �C �.a-, s � <br /> NES LJ NO <br /> Ti ern orotweq . I A ) ,--� ' C ! . „ <br /> ( C LLS - Anel ct Ink <br /> SAMPLE NUAWIPAS <br /> SA3,4PL@ ooNTAt11F.RS <br /> v 2 <br /> =UNPRf.�S S^AT, DIETALS <br /> rN91t(r . Ls'LC t,rraM1CAT. AiCtrALS <br /> 1'T CP ATaPs _- <br /> Yt' NlrliO(:,I�,v InDRhLS - - _ -. <br /> PT 'L'01'ALSIA:FIDR - <br /> TOTAL ORGANIC CARHON <br /> PF CHP;MICAL OS;VOEN nRaiAPTT .. <br /> rtA PNr? I.I(.S <br /> Omit VnA VTA1. 7°RA1t1EL BLANK <br /> 41311 VOA VIAL <br /> BPA I A <br /> PT OWR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> O enl VOA VIAL6 t[t - <br /> QT IKPA 30816'Ltt,Rfto <br /> QT EPA3154LOS15aS . .. <br /> OT ivittns <br /> T EFA525TIUVESLBLANK -.. . - <br /> domt Fa'A 347 <br /> 49m <br /> l EPA $311 <br /> Edz HPA 3f3 <br /> T B17A 5t99. <br /> TkarA <br /> W1 Arr 313'Ina AMBER <br /> 6ax1 )Poal3�ez ,7Ati <br /> SOIL SLEEVE ._ _.. -. <br /> PCB VIAL <br /> WDLAR BAG <br /> FERROUS IRON y <br /> ENCORE <br /> SMART KIT <br /> SL)MMA CAN"ISTSR <br /> ConAmenia7 .� � <br /> Sampler Nlrrrvatndng Completed ay: a Da1�lYlme: ary 21 06r7anot0 <br /> A = Actual I C = Corrected ._ " .. . . . . ... .. _.. <br /> The results in this report apply m the samples analysed in acconlance mith the chain ofcustruly document . This analytical report must he mpmduced in its entirely, <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 : 1000856214 4100 Atlas Court Bakersfield , CA 93308 (661 ) 327-4911 FAX (661 ) 327-1918 www. bclabs.com Page 4 of 30 <br />