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- ��boratory Since 1949 " <br /> Chain of Custody and Cooler Receipt Form for 1014400 Page 3 of 4 <br /> EIC I-ABORATORIES INC. SAMPLE RECEIPT FORM Rev,No.13 o613am0 Page _Of_� <br /> Submission#: \0 -( Qb <br /> T- <br /> S <br /> HIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express 0 UPS❑ Hand Delivery 0 Ice Chest ° None 0 <br /> I <br /> BC Lab Field Service 1 Other 0(Specify) Box O Other O..(Specify)' ' <br /> Refr7Seals <br /> -Blue Ice 0 None❑ Other O Comments: " <br /> Custest 0 Containers 0 None�-Comments: <br /> Yee D No Iuta.0 Yes No <br /> All sas NOD All samples containers intacl7 Yre�1 ,,,NoO Descriptionls)match COC? Ye o O <br /> COC.Received Emissivity: yr'1� Container:`J1•ytP Thermometer l0:J5 OateRime 10-13--(t� <br /> �FYES- ❑NO Tempealure:A a• 1 —C ITC � C1 C Analystfnil."'Dw tw <br /> SAMPLE CQNTAINERS t 1 3 3 11 6 5 5 1 e 9 l9 <br /> OT GENERAL MINERALI GENERAL PHYSICAL <br /> PT PE VNPRFSERVED <br /> T RIORCANiC CHEMICAL METALS <br /> PT HI RGAMCCNEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN PORMS <br /> PT TOTAL SU . <br /> .1 NITRATE I MTIDTE <br /> P'f TOTAL ORGANIC CARBON <br /> PT TON <br /> PT C16MICA3.OXYGEN DEMAND <br /> PIA PHENOLICS <br /> 60-1 VOA VIALTRAVEL 111. <br /> 40.1 VOA VW. I 1 1 1 I I 1 I 1 11 <br /> OT EPA 613.1 413.7,41 RA <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL 15 <br /> 60`mIYUA VI.AL506 <br /> T EPA 500160619080. . `1 <br /> T EPA.515.D5150 U <br /> T-EPA 535: <br /> T.EPK S35'PAF VEL BLANK <br /> 100.1 EPA 547. <br /> 100.1 EPA 531.1 <br /> T EPA 548 <br /> T EPA 569 a <br /> T EPA631 <br /> T EPA 0015M BORT O C <br /> Cr* NO NO OP <br /> T AMBER <br /> a OL JAR <br /> 33 OL JAR <br /> SOIL SLEEVE <br /> PCB VIAL - <br /> PLASTICHAG <br /> FERROUS IRON <br /> ENCORE <br /> Comments: ° 1 1 f <br /> Sample NDmboring Compluled By: DatetTlmc..1�711 <br /> A=Actual t C=Corrected - M:1eeC51WP3011A0_aCl51FORM515PMHEC2WPo1 <br /> The results to this report apply to the samples analy_ed in accordance frith the chain of custody document. This anal;tical report must be reproduced in its entirety. <br /> All results listed in this report are for the exclusive use of Lite submitting party BC Laboratories,Inc.assumes no responsibility for report allemnion separation,detachment orlhird puny interpretation <br /> 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www:bclabs.com Page 5 of 35 <br />