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BC LABORATORIES INC SAMPLE RECEIPT FORM Rev No 10 01/21/04 Page Of <br /> Submission # �fj Project Code TB Batch # <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> 1 Express ❑ UPS ❑ Hand Delivery D Ice Chest None D <br /> B ab Field Service ( Other O (Specify) Box Other ❑ (Specify) <br /> Refrigerant Ice Blue Ice ❑ None ❑ Other ❑ Comments <br /> Custody Seals Ice Chest ❑ Containers D None Comments <br /> Intact)Yes ❑No ❑ Intact?Yes iJ No <br /> All samples received? Yes No❑ All samples containers intact? Ye o❑ Descreptionis) match COCA Ye No D <br /> COC Received ice Chest ID Emissivity a 9q Date/Time <br /> YES ❑ NO Temperature =-C Container V)G& <br /> [TherEaggleter D Analyst Imt— <br /> SAM DMRF13S__- <br /> SAMPLE CONTAINERS 1 2 3 4 5 s <br /> 7 e 8 10 <br /> OT GENERAL MINERALI GENERAL PHYSICAL <br /> PT PE UNPRESERVED _ <br /> T INORGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> ioz.NITRATE/NITRITE <br /> 100m1 TOTAL ORGANIC CARBON <br /> T TOX <br /> PT GRUML <br /> AL OXYGEN DEMAND <br /> N OLICS <br /> 10ml VOA VIAL TRAVEL BLANK <br /> 10mi VOA VIAL r ( ri ( r i i e i r i i i i r <br /> TEPA 4131,413 2 418 1 <br /> IT ODOR <br /> tADIOLOGICAL <br /> IACTERIOLOGICAL <br /> 0 ml VOA VIAL-504 <br /> T EPA 508160818080 <br /> T EPA 515 118150 <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> 00m1 EPA 547 <br /> 00m1 EPA 531 1 <br /> �T EPA 548 <br /> oT EPA 549 <br /> ,T EPA 632 <br /> 1T EPA 801',M <br /> T QA1QC <br /> T AMBER <br /> OZ.JAR <br /> Z OZ JAR <br /> 7ILSI LEVr <br /> LA BAG <br /> -AROUS IRON <br /> VCORE <br /> ,nments <br /> nple Numbering Completed By Dat�ITime �7 _ <br />