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BC LABORATORIES INC SAMPLE RECEIPT FORM Re,Na. 13 06/34108 Page _ Of 5 <br /> Submission # \0'7u3Iq <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express ❑ UPS ❑ Hand Delivery '❑ Ice Chest None ❑ <br /> SC Lab Field Service 'Ef Other❑ (Specify) Box ❑ Other ❑..(Specify) <br /> Refrigerant: IceV Blue Ice ❑ None❑ Other❑ Comments: <br /> Custody Seals Ice Chest ❑ Containers❑ None' Comments: <br /> imacl7 Yes❑ No O Intact?Yes ❑ No ❑ <br /> All samples.received? Yes No❑ All samples containers intact? Yese No❑ Description(s)match COC? Yes No ❑ <br /> COC Received Emissivity: 01615 Container: Q-1-6b ThermomelerlD: kU3 DatefTime W-kd ih r] <br /> I YES O NO Temperature:A I ,U °C I C k'i D C Analyst Init <br /> SW <br /> SAMPLE CONTAINERS t Z a 4 s fi 7 8 s <br /> OT GENERAL MINERAII GENERAL PHYSICAL <br /> PT PE IINPRFSERVED <br /> T INORGANIC CREMICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SIJLFIDE <br /> 2az NITRATE/NITRITE <br /> PT TOTAL ORGANIC CARDON <br /> PT TOX <br /> PT C1IEMICAL OXYGEN DEMAND <br /> PIA PHENOLICS <br /> 40.1 VOA VIAL TRAVEL BLANK <br /> 40.1 VOA VIAL 1 I ) 1 I 1 1 1 I 1 I 1 I I I I I <br /> 7 EPA 413-1,413.2,418.1 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 ml VOA V1A1,504 <br /> T EPA 5 8/608/BOBO... <br /> T EPAJISX8150 <br /> T EPA 525 <br /> -T EPA 825 TRAVEL BLANK <br /> 100.1 EPA 547 <br /> 100.1 EPA 531.1- <br /> 7 EPA 548 <br /> 7 EPA 549 <br /> T EPA 632 <br /> 7 EPA 8015M <br /> OTAMBER <br /> 8 OZ JAR <br /> 32 OZ JAR <br /> SOILSLEEVF <br /> PCB VIAL <br /> PLASTIC BAG <br /> FERROUS IRON <br /> ENCORE <br /> Comments: <br /> Sample Numbering Completed By: Dalerrime: Q" — <br /> = - M:\pOCS\W PB011A6_OOCSIFORMS\SAMBEG2.WPD] <br /> A Actual I C=Corrected <br />