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_ � . <br /> Laboratories Inc. <br /> ' Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1523813 Page 2 of 2 <br /> ' SC LABORATORIES INC. �t c/ COOLER RECEIPT FORM Page--LOf <br /> Submission#: 1� ?i J(/ (3 <br /> SHIPPING INFORMATION SHIPPING CONTAINER FREE LIQUID <br /> Fed Ex D UPS D Ontrac D Hand Delivery O Ice Chest K None ❑ Box D YES D NO ❑ <br /> SC Lab Field Service IX Other D(Specify) Other D(Specify) <br /> Refrigerant: Ice SL Blue Ice❑ None❑ Other O Comments: <br /> Custody Seals Ice Chest O; Cotitamers❑ None l5g, Comments: <br /> 1 All samples received> Yes No D All sample.eontalners Inteet? Yez�No 11DeDescription(s)match CDC? You-14No ❑ <br /> COC Received Emissivity: Q•q7 Container: oThermometer lD:�]Dg _ DateRme C r1 �5 <br /> ' W,YES ❑ NO ram emture: I A I -C / (C I O j •C Analyst Ink <br /> —_ SAMPLE NUMBERS___--.— <br /> SAMPLE CONTAINERS <br /> 1 2 3 4 5 8 ] 8 9 la <br /> ' TPBUNP <br /> Jaz/8az/ tiaz EINPRES <br /> 2az Cr' <br /> INORGANIC CBENUCAL METALS <br /> ' mORGAMC CHEMICAL METAIS Jvz/eosll6oz <br /> For CYANIDE <br /> Pr NITROGEN FORMS <br /> PTT Tr SULPUW <br /> sm.NoThl NITRITE <br /> PC TOTAL ORGANIC CARBON <br /> PT CHEMIC"OXYGEN DEMAND <br /> M PHENOLICS <br /> ' 40m VOA VIAL TRAVEL BLANK <br /> JOm1 VOA V(AL <br /> QT <br /> EPA 1661 <br /> PMODOR <br /> ' RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 W VOA V W!SO4 <br /> T EPA SB&6089066 <br /> ' EPA515.1115e <br /> T EPA 525 <br /> TEYA52STRAVRLBLAN6 <br /> ' Quid"A 531.1 <br /> Baa RPA546 <br /> TEPASJ9 <br /> TEPANJISM <br /> ' <br /> BID/1 ]0 <br /> 6eztvml/32az AMBER <br /> Boz/I6az/Sias AR <br /> soasleevE <br /> ' PCB vw <br /> PLASMIC BAG <br /> TBDLAR BAG <br /> FERROUS MON <br /> ' ENCORE <br /> SMART= <br /> SfIN@TA CANLSTER <br /> —DaplSammple <br /> is Numbering Compbtetl By: DateRme. • Rev 20 0]/24(2016 <br /> A = Actual / C=Converted f�wr°°nw'°•."'u's-a°uvatwsuuauo..mt <br /> The res /r. in this upurr ppl,to the:,,q,1,, ",,done,is ithe he hriin of cn t dr docloinsin This nah( I pot ounst he reproduced in as ohn,li. <br /> All reNults lied-n this enter ore for the ezCh' use of the suhmnCnc park. BC Laboratories.Ino-'"tmesn sporstility for report alicrio .separation,denichurent or third pons interpretation. <br /> Report ID: 1000402732 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 vrww.bdabs.com Page 4 of 16 <br />