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1 <br /> — Laboratories Inc. <br /> ' — <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1204246 Page 5 of 6 <br /> 1 BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev.No.19 0612La3 Page Of <br /> Submission#: GL-04;4, <br /> SHIPPING INFORMATIONSHIPPING CONTAINER <br /> Federal Express 13S❑ Hand Delivery O Ice Ches None O <br /> BC Lab Field Service Other O(Specify) Box ❑ Other O(Specify) <br /> Refrigerant: Ice Bluelce❑ None El Other Comments: <br /> Custody Seals Ice Chest❑ Containers❑ Noned3 Comments: <br /> Int../?Yes No In 7 Yes No [[ <br /> ' All samples received? Ye NOCI All samples containers intact? Yes No O Description(s)match COC? Yes'O�No 0 <br /> COC Received Emissivity: U 1V Container:"Q- Thermometerl0: oatemme <br /> YES NO Temperature:A d •P 'C I C (•VI -C Analyst[nit <br /> Z� <br /> SAMPLE NI IMRFRS <br /> SAMPLE CONTAINERS 1 a r a i I I la <br /> OT GENERAL MINERAU GENERAL PHYSICAL <br /> ' PT PE ONPRESEIVrED <br /> T INORGANIC CHEMICAL METALS <br /> PT GJORGANIC CHEMICAL METALS <br /> PTCYANIDE <br /> ' PT NITROGEN FORMS <br /> PTTOTAL SULFIDE <br /> I.,MTRATE J M E <br /> PTTOTAL ORGANIC ON <br /> ' PT TOX <br /> IT CHEMICAL OXYGEN <br /> PIA PHENOLICS <br /> Chad VOA VIAL TIA,.!rEL BLANK <br /> 0.1 VOA VIAL r I I I t t t I r r t I <br /> T EPA e13.1413.24a. <br /> Pr ODOR <br /> RA 3IOLOCICAL <br /> BACTERIOLOGICAL <br /> 40 ml VOA VIAL-104 <br /> T EPA 509160MOSO <br /> T EPA 515,Its 150 <br /> T KFA 515 <br /> T EPA 515 TRAVEL BL.ANE <br /> 100aa1 EPA 347 <br /> 100.1 EPA 53 1.1 <br /> T EPA 543 <br /> T EPA 549 <br /> T EPA 631 <br /> ' T EPA SO ISM <br /> T AMBER <br /> 9 OL JAR <br /> 31 OL JAR <br /> ' SOILSLEEVE <br /> PCB VLA <br /> PLASTIC BAC <br /> FERROUS[RON <br /> ' ENCORE <br /> Comments: <br /> Sample Numberino Completed By: CAW Date/Time: <br /> A=actual I C=CorrectedlNaoOCSIWPOmuB-DMSvoRessSANascvweDI <br /> The results in this report apply to the samples analyzed fn accordance with the chain ofcusmdy document.This analytical report must be reproduced in its enthe y.. <br /> All results IistN in this report are for Ne exclusive use ofthe submitting May, BC Leboraton e.Inc.assumes no responsibility for repon alteration,separation,deochmenl or third parry interpremtion. <br /> ' 4100 ABas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 vJVJw.bclabs.com Page 8 of 88 <br />