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BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev.No.12 06/24/08 Page Of 1 <br /> Submission : <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express ❑ UPS❑ Hand Delivery ❑ Ice Chest/ None ❑ <br /> BC Lab Field Service X Other❑ (Specify) Box ❑ Other ❑ (Specify) <br /> Refrigerant: Ice p' Blue Ice❑ None❑ Other❑ Comments: <br /> Custody Seals Ice Gest Cl . Containers ❑ None/ Comments: <br /> Intact?:Yes 0:No t7 Intact �!es . -No. ❑ <br /> All samples received? Yes No❑ All samples containers intact? Yes No❑ Description(s)match COC? Yes/ No ❑ <br /> COC Received Emissivity: Container: Thermometer ID:IjaM Date/Time 1 Z• <br /> j�YES ❑ NO Temperature:A t °C f C °C Analyst Init W <br /> SA <br /> SAMPLE CONTAINERS ' 2 3 4 s 6 7 8 9 10 <br /> QT GENERAL MINERAU GENERAL PHYSICAL <br /> PT PE UNPRESERVED <br /> T INORGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 2oz NITRATE/NITRITE l <br /> PT TOTAL ORGANIC CARBON <br /> PT TOY <br /> PT CHEMICAL OXYGEN DEMAND <br /> PtA PHENOLICS <br /> 40ml VOA VIAL TRAVEL BLANK <br /> 40ml VOA VIA <br /> T EPA 413.1 413.2 418.1 NJ <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 ml VOA VIAL-504 <br /> T EPA 508/608/8080 <br /> T EPA 515.1/8150 <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> 100m1 EPA 547 <br /> 100m1 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 /> 32 OZ.JAR <br /> SOIL SLEEVE <br /> PCB VIAL <br /> PLASTIC BAG <br /> FERROUS IRON <br /> ENCORE <br /> Comments <br /> Sample Numbering Completed By: t Date/Time: <br /> A=Actual / C=Corrected iH:(DOCS%WPBOkLAB_DOCSTORMSDSAMREC2.WPDI <br />