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Laboratories Inc. Jik�_ <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1314316 Page 3 of 4 <br /> BC LABORATORIES INC. COOLER RECEIPT FORM Rev.No.15 07/01/13 Page I Of a <br /> Submission #: S I y / <br /> SHIPPING INFORMATION SHIPPING CONTAINER FREE LIQUID <br /> Federal Express ❑ UPS❑ Hand Delivery Ice Chest None ❑ Box ❑ YES ❑ NO ❑ <br /> BC Lab Field Service Other❑(Specify) Other ❑ (Specify) <br /> Refrigerant: Ice)? Blue Ice ❑ None ❑ Other❑ Comments: <br /> 3ustody Seals I a Co-• tate None Comments: <br /> e, <br /> all samples received? Ye No❑ All samples containers intact? Yes No❑ Description(s)match COC? Yes❑ No <br /> COC Received Emissivity: 0.CW Container: hA7 PE Thermometer ID: 20-7 Date/Time'7103 21LIO <br /> WYES ❑ NO <br /> Temperature: I A 1 I,,Z °C / (C ) L3 °C Analyst Init <br /> SAMPLE NUMBERS <br /> SAMPLE CONTAINERS <br /> 7 1 2 1 3 1 4 5 6 7 8 9 10 <br /> 1'GENERAL MINERAL/GENERAL . <br /> IT PE UNPRESERVED <br /> T INORGANIC CHEMICAL METALS <br /> 17-INORGANIC CHEMICAL.METALS. _._.... _...__.. - _...... <br /> IT CYANIDE <br /> IT NITROGEN FORMS <br /> IT TOTAL SULFIDE <br /> uz.NITRATE/NITRITE <br /> 'T TOTAL ORGANIC CARBON <br /> IT TOR <br /> IT CILEMICAL OXYGEN DEMAND <br /> IIA PHENOLICS <br /> 10m]VOA VIAL TRAVEL BLANK <br /> IOmI VOA VIAL <br /> T EPA 413.1 413.2 418.1 <br /> 'T ODOR <br /> IADIOLOGICAL <br /> IACTERIOLOGICAL <br /> 10 ml VOA VIAL-504 <br /> T EPA 508/608/8080 <br /> T EPA 515.1/8150 <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> 100m)EPA 547 <br /> 100a EPA 531.1 <br /> T EPA 548 <br /> T EPA 549 <br /> T EPA 632 <br /> T EPA 8015M <br /> T AMBERCr+E n <br /> 0 <br /> 3 OZ.JAR e12 <br /> CO <br /> 32 OZ.JAR - — <br /> TOIL SLEEVE <br /> PCB VIAL <br /> PLASTIC BAG I � <br /> FERROUS IRON <br /> ENCORE <br /> iMART KIT <br /> Summa Canister <br /> omments: k16 L;;�mpL[Ar6 -7'-//xiF,3 Al Q4S17Fs 0 <br /> ample Numbering Completed By: 1U.72 Date/Time: <br /> --1 t r r...........d tA-Am,nnCS\WoMParfnet\LAB D0CST0RMS\SAMRECI5J <br /> The results in this report apply to the samples analyzed in accordance with the chain of custody document.This analytical report must be reproduced in its entirety. <br /> All results listed in this report are for the exclusive use of the submitting party. BC Laboratories,Inc.assumes no responsibility for report alteration,separation,detachment or third party interpretation. <br /> 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.bclabs.com Page 5 of 30 <br />