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DC LABORATORIES INC. SAMPLE RECEIPT FORM Rev.No.12 06124106 Page a Of o <br /> Submission #: —MCMI <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express ❑ UPS ❑ Hand Delivery D Ice Chest� e None O <br /> BC Lab Field Service fl� Other O(Specify) Box O Other ❑.(Specify) <br /> Refrigerant: Ice Blue Ice ❑ None El Other ❑ Comments: <br /> Custody Seals Ice Chest ❑ Containers ❑ None -Comments: <br /> Intact?Yes[] NOD Intact?Yes O No ❑ <br /> All samples.received? Yes No❑ All samples containers intact? YIIIIee��1��1�1�11�^,,1�t,,,,N,,,,o D Description(s)match COC? Yes�YNo D <br /> COC Received =Emissivity: Container. Thermometer ID: �� DateRime 13 t� <br /> YES ❑ NOc I c aa� c Analyst)nit <br /> ZtZU <br /> a <br /> SAMPLE CONTAINERS 1 2 a q s i s 7 4 s 10 <br /> OT GENERAL MINERA6 GENERAL PHYSICAL <br /> PT PE UNPRFSERVED <br /> T INORGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 2oz NITRATE I NITRITE <br /> PT TOTAL ORGANIC CARBON <br /> PT TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> PIA PHENOLICS <br /> 40.1 VOA VIAL TRAVEL BLANK <br /> 40ml VOA VIAL 1 1 ! 1 1 1 11 1 I I 1 1 1 1 11 <br /> TEPA 413.1 413.2 418.1 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICALL <br /> 40 IDI VOAlVIA504 <br /> T EPA 508160818080. <br /> T EPA.515.118150 <br /> T EPA 525.. <br /> T EPA k5 TRAVEL BLANK <br /> 100.1 EPA 547 <br /> 100.1 EPA 531.1 . <br /> T EPA 548 <br /> T EPA 549 . - <br /> T EPA 632 <br /> T EPA 30I5M <br /> T AMBER <br /> 8 OZ JAR <br /> 32 OL JAR <br /> SOIL SLEEVE ' <br /> PCB VIAL <br /> PLASTIC DAC - <br /> FERROUSIRON <br /> ENCORE <br /> Comments: <br /> Sample Numbering Completed By: I Date/Time: �. <br /> A =Actual I C= Corrected M:1DOcs1WPe011 a OOCSIFORM616AMREC2.WPOI <br />