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BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev No. 10 01121104 Page -L Of <br /> Submission #_ os— 76 t Code: TB Batch # <br /> SHIPPING INFORMATION=' SFj1PPING CONTAINER <br /> FeriPral Express ❑ _ UPS ❑ Hand DelIce Chest None ❑ <br /> B Field Service lg' Other ❑ ISpecilyBox El Other ❑ (Specify)_ <br /> Refrigerant: Ice Blue Ice ❑ None ❑ Other © Comments: <br /> jCustody Seals: Ice Chest ❑ Containers L1 None Comments: <br /> LIntact? Yes 0 No b Intact? Yes o No <br /> All samples received? Yes C4 No U All samples containers intact? Yes(�Np❑ Descriptionlsi match COC? Yes I-No ❑ <br /> i�OC Received Ice Chest 1D - Emissivity V DatelTime <br /> YE$ ❑ NO Temperature:--. •C Container <br /> Th r ID Analyst ]nit <br /> SAMPLE CONTAINERS <br /> OT GENERAL MINERAL/GENERAL PHYSICAL <br /> PT PE UNPRESER V ED <br /> T INORGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 2oz.NITRATE!NITRITE <br /> I00m1 TOTAL ORGANIC CARBON <br /> T TOR <br /> FT CHEMICAL OXYGEN DEMAND <br /> PIA"•'fNOL1CS <br /> 40n A VIAL TRAVEL BLANK <br /> 40m1%rOA VIAL e i 3 s r <br /> T EPA 417.E 417 2 4 18.1 <br /> PT ODOR <br /> RADIOLOGICAL <br /> SACT ERIOLOG ICA L <br /> 40 ml VOA VIAL-504 <br /> T EPA 5081608!8080 <br /> T£PA 515.1181-4 Ci K B <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANKS B- <br /> 100MI EPA 547 <br /> I00ml EPA 512.1 <br /> T EPA 548 <br /> T EPA 544 <br /> T EPA 672 <br /> T EPA 8015M <br /> T QAC <br /> T AMBER <br /> 802 JAN <br /> 72 07- JAR <br /> SOIL SLFF VE <br /> PCB VIAL <br /> 1'L, BAG <br /> FF,RS IRO, <br /> ENCORF_ <br /> ;omment s <br /> iample Numbering Completed By- Date/Time <br /> 1H.kDOCSIWPBO5LAe DOCS%FOFLLdSYSAMREC2_WPDI <br />