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BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev.No.12 06124108 Page. .,Of <br /> SubmissioncNA <br /> SHIPPING INFORMATION HIPPING CONTAINER <br /> None 0 <br /> Federal Express P UPS 0 Hand Delivery 0 Ice Chest <br /> BC Lab Field Seoice 0 Other 0(Specify) I Box 0 Other 0(Specify} <br /> Refrigerant: is Blue Ice 0 None 0 Other 0 Comments: <br /> Custody Seals Ice ChestContainers 0 Non79 Comments- <br /> 1 Int Y" .'I intact?Yes 0 No 0 1 <br /> Ali samples received? Yes) No All samples containers intact? Yes Noo Description(s)match COC? Yes/ No 0 <br /> 1 1 1 <br /> COC Received Emissivity: Thermometer IM-1-ty,ka-01 <br /> -C\?-') Container:' Datefrime W raj <br /> YES 0 NO <br /> i. Temperature:A ----c C C Analyst Init <br /> SAM LEbIUMBEBS <br /> SAMPLE CONTAINERS 2 3 4 6 g 7 a S 10__ <br /> OT GENERAL MINERAL!GENERAL PHYSICAL <br /> PT PE UNPRESERVED <br /> 2T INORGANIC CHEMICALMETALS <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 2oz.NITRATE I NITRITE <br /> PT TOTAL ORGANIC CARBON <br /> PT TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> PtA PHENOLICS <br /> 40ml VOA VIAL TRAVEL BLANK <br /> 40ml VOA V16L L Ma) <br /> 9T FPA413.1,413.2,418.1, <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 ad VOA VIAL,504 <br /> 2T EPA 506/608=80 <br /> EPA 515.1/8150 <br /> IQT EPA 52-5 <br /> 5 TRAVEL BL NK <br /> 100mi EPA 547 <br /> 100ml EPA 5313 <br /> OT EPA 548 <br /> OT EPA 549 <br /> QT EPA 63 <br /> 2 <br /> QT EPA 8015M <br /> QT AMBER <br /> 8 OL JAR <br /> 32 OZ.JAR <br /> SOIL SLEEVE <br /> PCB VIAL <br /> PL6ZIC BAG <br /> FERROUS IRON <br /> ENCORE <br /> Comments- <br /> Sample Numbering Completed By: Date/rime: 1-1&Lff W7 '70U <br /> A-Actual 1 C-Corrected [H:\DOCS%WPSOWM_DOCSIFORMS1SAMREC2.WPDI <br />