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BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev. No. 92 08f24f08 Page 'G -Of <br />Submission #: E)q— <br />SHIPPING INFORMATION SHIPPING CONTAINER <br />Federal Express ❑ UPS ❑ Band Delivery ❑ Ice Ches d None ❑ <br />C Lab Field Service' Other ❑ (Specify) Box ❑ Other ❑ (Specify) <br />Refrigerant: Ice , Blue Ice ❑ None ❑ Other ❑ Comments: <br />Custody Seals <br />Ice chest a <br />intact? Yes No <br />Containers a <br />to ct? es No <br />None'd comments: <br />All samples received? Yes ❑ No o All samples containers intact? Yes ❑ No ❑ Description(s) match COC? Yes ❑ No ❑ <br />COC Received Emissivity,O. Container: p}� 2 Thermometer tD —Cgn_t�$p Datetiimeg _q 22to <br />❑ YES ❑ NO O <br />Temperature: A 1 .2 . °C 1C IM °C Analyst Init 1�N� <br />SAMPLE CONTAINERS 1 271 3 1SAMPIF <br />4 5 e a S <br />OT GENERAL MINERAL/ GENERAL PHYSICAL 10 <br />PT PE UNPRESERVED <br />JOTINORGANICCHEMICAL METALS <br />PT INORGANIC CHEMICAL METALS <br />PT CYANIDE <br />PT NITROGEN FORMS <br />PT TOTAL SULFIDE <br />2o7. NITRATE / NITRITE <br />PT TOTAL ORGANIC CARBON <br />PT TOX — <br />PT CHEMICAL OXYGEN DEMAND <br />PLA PHENOLICS <br />40ml VOA VIAL TRAVEL BLANK <br />I VOA VIAL t t t t t ( t I 1 t t 1 ) t 1 I <br />EPA 413.1 413.2 418.1 <br />PT ODOR <br />RADIOLOGICAL <br />BACTERIOLOGICAL <br />40 ml VOA VIAL 504 <br />T EPA 5081608/8080 <br />T EPA 515.1/8150 <br />T EPA 525 <br />T EPA 525 TRAVEL BLANK <br />100m] EPA 547 <br />I00m1 EPA 531.1 <br />T EPA 548 <br />T EPA 549 <br />T EPA 632 <br />T EPA 8015M <br />T AMBER <br />8 OZ JAR <br />320 JAR <br />SOIL SLEEVE <br />PCB VIAL <br />PLASTIC BAG <br />FERROUS IRON <br />:omments: <br />1e Numbering Completed By: DatefTime: <br />tual / C = Corrected IH:%DOCSIWPBO%L46 DOCS\FORMS%SAMREC2.WPDI <br />