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LABORATORIES INC. SAMPLE RECEIPT FORM Rev.No.11 o4io4las Page Of <br /> mission #: ' Project Code: TS Batch # <br /> HIPPING INFORMATION SIPPING CONTAINER <br /> eral Express LIDS 0 Hand Delivery © Ice Chest None 0 <br /> Lab Field Se vic Other O (Specify) Box © Other 0(Specify) <br /> rigerant Ice Blue Ice© None❑ Other D Comments: <br /> tody Seats: tit iwtki7t T1 E Cl' None Comments: <br /> Ixitacs;?Yes Ma- ftrteot?^�c+ Gl Ple <br /> amples received? Ye No❑ All samples containers intact? es No Q Description(s)match Cee? Y 010 <br /> OC Received Ice Chest ID Emissiv'rLy Die tme <br /> ES NO Temperature C ContainerLq'j�f sf�J <br /> ' e r <br /> SAEfiPLF NUMBERS <br /> SAMPLE CONTAINERS a 2 3 a s s 7 8 s 10 <br /> ENERAL MINERAU GENERAL PHYSICAL <br /> 3UNPRESERVED <br /> SORGANIC CHEMICAL METALS <br /> (ORGANIC CHEMICAL METALS <br /> VANIDE <br /> ITROGEN FORMS <br /> )CAL SULFIDE <br /> TITRATE/NITRITE <br /> TO'T'AL ORGANIC CARBON <br /> DX <br /> IEMICAL OXYGEN DEMAND <br /> HENOLICS <br /> VOA VIAL TRAVEL BLANK r1 <br /> VOA VIAL <br /> RA 413.1 4T3.2 419.1 <br /> DOR <br /> OLOMCAL <br /> 'ERIOLOGICAL " <br /> VOA VIAL-504 <br /> PA 508/608/8080 <br /> 1A511,V8150 <br /> PA 525 <br /> PA 525 TRAVEL BLANK <br /> EPA$47 <br /> EPA 531.1 <br /> PA 548 <br /> tiA 549 <br /> PA 632 <br /> PA 80151) <br /> rU <br /> ' Vi <br /> JAR <br /> :.JAR <br /> SLEEVE <br /> VIAL <br /> Tic BAG <br /> :OUS IRON <br /> )RE <br /> tents- <br /> a Numbering Completed By: Date/Time: Gv <br /> \Ctual I C = Corrected - IH:IDOCS\WPBO\LAB DOCStfORMSISAMRECZ.WPD1 <br />