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BC LABORATORIES INC. 11 SAMPLE RECEIPT FORM Rev.No.12 06/2410.0 Pase Of <br /> Submission #: w l"3 <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express ❑ UPS ❑ Hand Delivery ❑ Ice Chest None ❑ <br /> BC Lab Field Service Ef Other❑ (Specify) Box ❑ Other ❑.,(Specify) <br /> Refrigerant: Ice'p Blue Ice ❑ None❑ Other ❑ Comments: <br /> Custody Seals Ice Chest❑ Containers O None Comments: <br /> Intact?Yes O No❑ Intact?Yes ❑ No ❑ <br /> All samples.received? Yes No❑ All samples containers intact? Yes/f No❑ Description(s)match COC? Yes No ❑ <br /> COC Received Emissivity: 010(S Container: ThermometerlD: Date/Time <br /> i YES ❑ NO Temperature: A 1 .l4 °C I C 1 C Analyst Init JIJt j <br /> SAMP <br /> SAMPLE CONTAINERS q 5 SL6 p-7 'L9 9 10 <br /> 07 GENERAL MINERAL./GENERAL PHYSICAL <br /> PT PE 11NPRESERVED <br /> T INORGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 2oz 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 <br /> 40.1 VOA VIAL <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 508/608/8080. <br /> T EPA 515.118150 <br /> T EPA 525 <br /> OT EPA k5 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 /> 7 AMBER <br /> 8 OZ JAR <br /> 32 OZ JAR <br /> SOILSLEEVE <br /> PCB VIAL <br /> PLASTIC BAG <br /> FERROUSIRON <br /> ENCORE <br /> .r <br /> Comments: <br /> Sample Numbering Completed By: Y Date1Time: Q— — <br /> A=Actual I C=Corrected - IH:\O=WPOMLAa_DOCMFORMSISAMREC2.WPDi <br />