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BC LABORATORIES INC. kj 5-17 - SAMPLE RECEIPT FORM Rev.No. 12 06/24/08 Page Of <br /> Submission #r: <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express ❑ UPS ❑ Hand Delivery ❑ Ice Chestlo None ❑ <br /> BC Lab Field Service ,!4 Other ❑ (Specify) Box ❑ Other ❑ (Specify) <br /> Refrigerant: Ice 0 Blue Ice ❑ None ❑ Other ❑ Comments: <br /> Custody-Seals Ice:Chest ❑ ContaiFis�.❑ Noneo Comments: <br /> Intact?Yes❑ No❑ Intact?Yeo ❑ <br /> Allsamples received? Yes❑ No❑ All samples containers intact? Yes❑ No❑ Description(s)match COC? Yes❑ No ❑ <br /> COC Received Emissivity: 6\9S Container: Thermometer ID:-4fr iLQ Date(fime <br /> YES ❑ NO t� L Analyst Init , <br /> Temperature:A 0 `C I C a, `C Y <br /> SAMPLE <br /> SAMPLE CONTAINERS 39 �c 41 V —51� <br /> < _ <br /> QT GENERAL MINERAL/GENERAL PHYSICAL 0 <br /> PT PE UNPRESERVED <br /> T INORGANIC CHEN4ICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORAIS <br /> PT TOTAL SULFIDE <br /> 2o7.NITRATE/NITRITE , <br /> PT TOTAL ORGANIC CARBON <br /> PT TOX <br /> PT C14EN-IICAL OXYGEN DEMAND <br /> PtA PHENOLICS <br /> 40m1 VOA XgALTRAVEL BLANK <br /> -'Duul VOA VLA_l. 1 1 1 1 1 I 1 1 I 1 I 1 1 1 1 I t I <br /> T EPA 413.1 413.2.418.1 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL _ <br /> 40 ml VOA VIAL-504 <br /> OT EPA 508/608/8080 <br /> T EPA 515.1/8150 - <br /> OT EPA 52-5 <br /> OT EPA 525 TRAVEL BLANK <br /> I00mlEPA 547 <br /> 100ad EPA 531.1 <br /> T EPA 548 <br /> T EPA 549 <br /> T EPA 632 <br /> T EPA 8015N7 <br /> OT AMBER <br /> 8 OL JAR <br /> I <br /> 32 OZ.JAR I I I <br /> SOIL SLEE1,7E <br /> PCB VIAL <br /> PLASTIC BAG I <br /> FERROUS IRON I I I ! ! <br /> ENCORE <br /> Comments: <br /> Sample Numbering Completed <br /> A. = Actual / C= CorrEcted F:;\GCC SRNF 6C'.�l,o,i'CCS\F�^,P.Mi j\$=`.IdREC[.VVPD1 <br />