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BC LABORATORIES INC SAMPLE RECEIPT FORM Rev loo to 01/21/04 Page Of <br /> Submission # �.3 Project Code TB Batch # <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express Cl UPS ❑ Hand Delivery ❑ Ice Chest R'- None ❑ <br /> �ab Field Service P_f� Other ❑ iSpecifyl Box ❑ Other ❑ (Specify) <br /> Refrigerant Ice 0� Blue Ice ❑ Norte ❑ other © Comments <br /> Custody Seafs Ice Chest ❑ Containers ❑ None Q- omments <br /> Intact" Yes O No intact"Yes ❑ Na <br /> All samples received) Yes/6- No 0 All samples containers tntact> Yes g--No❑ Descripttonlst match COC'2 Yew'No ❑ <br /> CO Received ='Trempehrat,iuce- <br /> t In� Emissivity } DatefTime e <br /> ES C3 NO -C Container c�i+.4 <br /> ID, $' Analyst Ina <br /> I <br /> SAMPLE NUMBERS <br /> SAMPLE CONTAINERS * 2 3 / 4 6 ii 6 f 9 s <br /> OT GENERAL fAINERALI GENERAL PHYSICAL <br /> PT PE UNPRESERVED <br /> T INORGANIC CHEMICAL METALS <br /> P r INORGAN]C CHEN914CAL METALS <br /> PI-CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> tor-NITRATE 1 NITRITE <br /> 100mi TOTAL ORGANIC CARBON <br /> T TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> PtA HENOLICS <br /> 49MA VIAL TRAVEL SLANK r� <br /> 40ml OA VIAL tP ' &2 , i i i iG i ZB s <br /> 7EPA 4131 4132 4191 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 413 mi VOA VIAL-504 <br /> T EPA 508/60919094 <br /> T EPA 515 119150 <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> 100mi EPA 547 <br /> 100mt EPA 531 1 <br /> T EPA 548 <br /> T EPA 549 <br /> T EPA 632 <br /> T EPA 90I5M <br /> T QAJQC <br /> T AMBER <br /> 8 OZ JAR <br /> 32 OZ,JAR <br /> SOIL SLELVE <br /> PCIS VIA] <br /> 1'L AAG <br /> IAF. S IRAN <br /> ENCORE. <br /> ornmenis <br /> ample Numbering Completed llyG� „J Date/Time G, <br /> IH%OOCS%WPB04LA6 DOCS1Fo RmStSAMREC2 WpC <br />