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LABORATORIES SAMPLE RECEIPT FORM <br />Lab Number i 4�nV <br />Time Rec . 9i , L Ll <br />SHIPPING SPECIFICATIONS: <br />Federal Express <br />UPS <br />BC Lab Field Service <br />Hand Delivery <br />Other (Specify) <br />SAMPLE CONDITION: <br />Temperature �� - C c - <br />Date Rec . 1-1V <br />Rec . By: L4 - <br />SHIPPING CONTAINER: <br />-'f Ice Chest <br />None <br />Other(Specify) <br />Ice Blue Ice None <br />If temperature is not between 2 and 6 C please explain: <br />Custody Seals: <br />Ice Chest <br />Containers None <br />All samples Received: Y <br />N <br />All samples intact: <br />Y <br />N <br />Descriptions match <br />COC: i Y / <br />N <br />SAMPLE CONTAINERS• <br />t QT PE UNP « <br />TOC <br />BACT <br />QA/QC <br />PT PE UNP <br />TB <br />504 <br />QT AMBER <br />QT MET <br />VOA SET <br />507 - <br />8 OZ JAR <br />PT MET <br />VOA VIAL <br />508 <br />32 OZ JAR <br />CN <br />COD <br />515.1 <br />OTHER <br />N FORMS <br />OIL & GR <br />525 <br />i SULFIDE <br />ODOR <br />547 <br />__�__NO3/NO2 <br />RADIO <br />531.1 <br />Comments: <br />Completed by:' <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 />41 CO Atlas Cr— • Bakers�:eld, CA 93308 • (605) 327-491 1 • FAX (805) 327-191 8 <br />