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IM� <br /> Laboratories Inc. �� �►1 <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1012151 Page ll of 13 <br /> aC"XICRATORIES RNC. SAMIPLE RECEIPT FORM N++,Np.a asrz+.ca Page 1 Of <br /> Submission 9: — <br /> SHIPPING INFORMATION SHIPPING CONTAINER t <br /> Federal Express 0 .r � <br /> iUPS 0 Nand Delivery 0 - Ice Chest PC None 0 <br /> BC Lab Field Service T Other O lS pecify) Bax 0 Other 0(Specify) <br /> Refrigerant: lcoo Blue Ice O None 0 Other 0 Comments: <br /> Custody Seals Cest p ntiners O None Comments.oa <br /> <• tbO nh<t7 Yna Ro <br /> All same"Mc4th*d? Y94 Noa ARI 1ampt*4 containers intact? Yes No❑ oeecr(p(lon(s)match COC? Yes No 0 <br /> C1C Received Emissivity: j� CDrdslrmr:� Thermoanererl0: itA� Dlfenime �1 ID <br /> I YES ONO Temperature:A 1 C r t LA,4 C Analy.t InitINDLA Z <br /> I _ <br /> +AAIPLE CONTAIMERS 1 3 t S s f ! Ip <br /> Or GENERAL SAINEPW GENERAL MP(S CAL <br /> FT PL UWPYSMVED <br /> OTIN GAM,1,1IICALWSALv <br /> PTegl?IGArICCNZNIICA dVrALS II <br /> PT CYANIDE F <br /> PTNITA T-Mm" <br /> r TOTAL SULFIDE. <br /> a N7 ATS I N"krrE _ <br /> PT TOTAL ORGAN C ARB60 t <br /> PT T T <br /> PT CIIEPII CAL Q?,):reN pkat <br /> PIX PI{r110i.IC5 <br /> +a.lY 1 > TRAYEL OLAN <br /> K.�,�,.)OLIDGICAL <br /> IAL 1 I Kira <br /> l <br /> t J13� 416.I <br /> 1CA1.DGICSL",&MGQj A .IAM <br /> QT EP{3x= _ <br /> EFA$-45 TRAVEL BLANK <br /> laaml EPA Z17 <br /> 140.1 EP-3 SJt.I i <br /> OT M+5* <br /> QT <br /> r T.PA 63' <br /> OT LTA 9e14Y1 r. ) <br /> OT AMBER 1 a <br /> a JAA <br /> 32 47_JAR _ <br /> SGIL SLEEVE <br /> CCB P3zL ��" <br /> P r :�_ <br /> .FERR4llc IRON . <br /> ILMCORL _ <br /> Sample Numbering Cpmpiptod ify' Ooiall'im¢ _ '-' � <br /> 1\+E�F�1 ! f-rnnlAr'hr1 - [+FS�aMve>sgt_all"a'FCn•Y'pISAMIIE\1'!/Ppl <br /> Thee-vdr =':hes renorl applyra rhe Aampfu anolyceA in accord;:^.,_ndrh the Chain ofevrlody dotvmenG This anohxi;u!:• ,.v;;�3r be reprorivicedin itT enlirey. <br /> All resulu l,a=,i n I�p coon+re for Ne eaduaive uu of the nhmininp parry n� !aowsiorin,Iw.usuma no ras0mibeiry rot report+hencur.�J. c,deachmem or third parry imerprwtioa <br /> 4100 Atlas Court Bakersfield,Ci P'a?Oc ,661)327-4911 FAX(661)327-1918 w.,-v1-.c--,,0m Pag 11 of?.' <br />