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Laboratories, Inc. <br />Environmental Testing Laboratory Since 1949 <br />Chain of Custody and Cooler Receipt Form for 1101450 Page 2 of 2 <br />3C LASORATORIES ENC. <br />SAM LE RECEFPT FORM R.tw, tsa t t a&Ftan13 P3 C - _ Qf <br />Submission #: <br />SKIPPING INFORMATION S141PPING CONTAINER <br />Federal Expr ss UPS A <br />Hand ©elivcry ice Chest/Ey Nene C7 <br />BC Lab Field Service other 0 (Spe'cify) Box D othor Q,(Speci )®—� <br />R:efrlgeraflt. let 81ue Ice D (done D Other D Comments: <br />Custody Seats ice Chest 0 <br />Containers; tdortedG Comments; - <br />I est? Yts 'N C] <br />Intact? Yc: Li II <br />C 1 <br />All samples received?' Y no C <br />AM tsaenpies cottta acTS 111tbal ye -FAD no D D rriPOP1t(s) match CoC2 1' Nm C3 <br />COC Received <br />emissivity: � Container, Q=- = Theimometcrlo_�K DatoTimeAbeT;t <br />YES L-1 <br />LI N{} <br />Te R -3 -LL --c I C r 'G Artalyg! Init. <br />SAMPLE CgWTAINERes <br />t ! 3 t 5 r e ] N <br />OT MeNErtAL NINE RAtI G� E41EdiAt PHT51 _ _.... . - <br />jWfh 'VPigE�ERVED _ '. <br />T lN6xC,ANrc CltI MICAL K9 L5 <br />t'T.ANICCNEMICALOA •TALS <br />4" <br />PT CYAMDE <br />_......_ <br />PT NITROGEN FORMS, <br />- <br />PT TOTAL SULF1 <br />. . <br />jn,,NMtATEtNrrjuTE <br />_... . <br />PT TOY'AL ORGA'#PIC.. ARKM <br />Tox <br />PT CHEMICAL DXYCEN nFMAND <br />Pia,P <br />_ <br />46au1 VOA VIAL TRA VE NK <br />- ..... <br />ml V VLA <br />PT ODOR <br />_ <br />,IOt 9W A... <br />-_.. ..... <br />enCPFlucILOCtrAL <br />_. -. ... <br />&06.1 VOA Vi43_-304 <br />_.. <br />i r?A 5081"843986 <br />.. - . <br />T EPA 515.t1&Ij6 <br />.. - <br />T EPA a'ta <br />.._... __ .. ..�:. <br />T UP.( 3!5.TRAVEL 8LA 19 <br />1Eand EPA SO <br />l Ottwr EPA 57l. [ <br />T EPtsi6 <br />T £PA Sag <br />T EPA "I <br />r EPA aftsm <br />T AMEER <br />a fit 3A$ <br />_ <br />]] GL IAA <br />SOIL SI.M—C <br />PCB VIAL <br />0L.-%,rrsc8� C <br />FERROUS <br />ECYQ]aE <br />_. <br />Ctarnmants: <br />SatWe Ntrrt,bering <br />L3ateTr1ma: <br />7 itr Ext s 5aert+ Gt.sr* <br />A - Arivat t C = Corracted <br />pf 6i" .vPswLAa <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.bciabs.com Page 4 of 16 <br />v <br />[]I <br />a <br />