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BC LABORATORIES INC. SAMPLE RECEIPT FORM Re,No.12 06/24/06 Page -a Of S <br /> Submission #: i0-0-(319 <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Chest None ❑ <br /> Federal Express ❑ UPS ❑ Hand Delivery ❑ Ice Box ❑ Other ❑..(Specify) <br /> BC Lab Field Service If Other❑ (Specify) <br /> Refrigerant: Ice'p Blue Ice ❑ None ❑ Other ❑ Comments: <br /> Custody Seals Ice Chest ❑ Containers ❑ None Comments: <br /> Intact?Yes❑ Non Intact?Yes ❑ No ❑ <br /> All samples.received? Yes ND❑ All samples containers intact? YeS9 No❑ Description(s)match COC? Yes No ❑ <br /> �5 Container:� Thermometer ID: ) DeleRime <br /> COC Received Emissivity: �__ <br /> YES ❑ NO Temperature:A I ,l9 °C 1 C C Analyst Init J1JQ <br /> SAMPLE CONTAINERS 1 2 2 4 5 s ? e e 10 <br /> OT GENERAL MINE RALI GENERAL PHYSICAL <br /> PT PE UNPRESERVED <br /> T INORGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PTTOTALSULFIDE <br /> 2.a.NITRATE/NITRITE <br /> PT TOTAL ORGANIC CARBON <br /> PT TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> PIA PHENOLICS <br /> 40.1 VOA VIAL TRAVEL BLANK 11 1 11 <br /> 40.1 VOA VIAL I I 1 I 1 1 11 I 1 I I <br /> T EPA 413.1 413.2 418.1 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40.1 VOA VIAL 504 <br /> T EPA 508160818080... <br /> T EPA.515.1/8150 <br /> T EPA 525 <br /> T EPA 825 TRAVEL BLANX <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 8015M <br /> T AMBER <br /> 8 07-JAR <br /> 32 OZ]AR <br /> SQILSLEEVE <br /> PCD VIAL <br /> , PLASTIC BAG <br /> FERROUS IRON <br /> ENCORE '. <br /> Comments: " <br /> Sample Numbering Completed By: J Dalefrime: O" — \ pg\DOCS%WPOoLLAR DOCSIFORMSISAMREC2.WPD1 <br /> A=Actual 1 C= Corrected - <br />