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BC LABo ATORIES INC SAMPLE RECEIPT FORM Rev No io 01/21/04 Page ^ Of <br /> Submissibn # 9 164 Project Code 1 TB Batch # . <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> F ral Express ❑ UPS ❑ Hand Delivery ❑ Ice Chest None ❑ <br /> b Field Service Other ❑ (Specify) Box Other ❑ (Specify) <br /> Refrigerant ice Blue Ice ❑ None ❑ Other ❑ Comments <br /> Custody Seals Ice Chest ❑ Contalners ❑ None Comments <br /> Intact? Yes ❑No ❑ Inlact,Yes ❑ No <br /> Ail samples received? Ye No❑ All samples containers intact? Ye No❑ Descriptlonlsl match COC? Y No ❑ <br /> COC Received ice Chest ID Emissivity [An:.:Iy.t <br /> eC}-{..'o+ <br /> YES [J NO Temperature °C Container �T <br /> h r D )nit <br /> SAMPLE NIJbdRFRS <br /> SAMPLE CONTAINERS 11 2 3 14 16 7 IS <br /> QT GENERAL MINERAL/GENERAL PHYSICAL <br /> PT PE UNPRESERVED <br /> 7 IN RGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 2oz NITRATE/NITRITE <br /> 100m1 TOTAL ORGANIC CARBON <br /> T TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> P NOLICS <br /> 4 AVIALTRAVELBLANK r +� <br /> 40m1 VOA VIAL ) 1 P_J r 3 M. ,s r <br /> T EPA 413 1 413 1 418 1 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 ml VOA VIAL,504 <br /> T EPA 508/608/8080 <br /> T EPA 515 118150 <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> I00mIEPA 547 <br /> 100ml EPA 531 1 <br /> T EPA 548 <br /> QTEPA 549 <br /> T EPA 632 <br /> T EPA 801 SM <br /> T OALQC <br /> T AMBER <br /> 8OZ,JAR <br /> 32 OZ IAR <br /> SOIL SI E P VI <br /> PCB VIAL <br /> 1'Q&BAG <br /> PFR OUS IRON <br /> ENCORE <br /> umments <br /> 3rnple Numbering Completed By DBIelTime <br /> 1H tDOCSVWPBO%LAB DCCSIFORMSISPMAEC2 WPDI <br />