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Laboratories Inc. _ <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1601186 Page 4 of 4 <br /> BC LABORATORIES INC. COOLER RECEIPT FORM Page 2 Of Z <br /> Submission#: - ff <br /> SHIPPING INFORMATION SHIPPING CONTAINER FREE LIQUID <br /> Fed Ex ❑ UPS❑ Ontrac❑ Hand Delivery ❑ Ice Chest None ❑ Box ❑ YES ❑ NO ❑ <br /> BC Lab Field ServiceK Other❑(Specify) Other n(Specify) <br /> Refrigerant: Ice Blue Ice❑ None❑ Other❑ Comments: <br /> Custody Seals !ce Chest❑ Contamers'O.: None l Comments: <br /> ,,l <br /> All samples received? Yes No❑ All samples containers intact? Yles_ No❑ Description(s)match COC? Yes No ❑ <br /> COC Received Emissivity: �� C/ontainer: Thermometer ID: Date/TimeZp3 <br /> YES NO Tem erature: (A) 6 C ) f °C Analyst InitC JJ <br /> SAMPLE NUMBERS <br /> SAMPLE CONTAINERS <br /> 2 3 l 4 5 6 7 8 9 10 <br /> T PE UNPRES <br /> 40z/8oz/16oz PE UNPRES <br /> 2oz Cr.' <br /> T INORGANIC CHEMICAL METALS <br /> INORGANIC CHEMICAL METALS 4oz/Soz/16oz <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 2oz.NITRATE/NITRITE <br /> i <br /> PT TOTAL ORGANIC CARBON <br /> PT CHEMICAL OXYGEN DEMAND <br /> i <br /> PIA PHENOLICS - <br /> 40m]VOA VIAL TRAVEL BLANK <br /> 40m1 VOA VIAL 3 <br /> T EPA 1664 <br /> PT ODOR <br /> RADIOLOGICAL 1 <br /> BACTERIOLOGICAL <br /> i <br /> 10 ml VOA VIAL-504 <br /> i <br /> T EPA 5081608/5080 <br /> T EPA 515.1/8150 <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> Oml EPA 547 <br /> a <br /> Oml EPA 531.1 <br /> oz EPA 548 <br /> IT EPA 549 tl <br /> ,T EPA 8015M <br /> T EPA 8270 <br /> ,z/16oz/32o.AMBER <br /> R <br /> a/16oz/32oz JAR <br /> SIL SLEEVE <br /> "B VIAL <br /> .ASTIC BAG f <br /> 'sDLAR BAG <br /> :RROUS IRON <br /> ZCORE e <br /> IART KIT j <br /> MMA CANISTER § <br /> nments: <br /> 1ple Numbering Completed By: Date/Time: + Rev 20 07/24/2015 <br /> Actual / C = Corrected (S:\WPDudW,,dPe,lett\LAB_DOCSIFORMS{SAMREC—20] i <br /> The results in this report apply to the samples analyzed in accordance with the chain of custody document.This analytical report must be reproduced in its entirety. <br /> All results listed in this report are for the exclusive use of the submitting party. BC Laboratories,Inc.assumes no responsibility for report alteration,separation,detachment or third party intermetation. <br /> Report ID 1000439944 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.bclabs.com Page 6 of 30 <br />