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BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev. No.12 06/24/08 Page Of <br /> Submission MM-OT31,19 I T <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express 0 UPS 0 Hand Delivery 0 Ice Chest None 0 <br /> BC Lab Field Service Other 0 (Specify)_--.-- Box 0 Other 0 (Specify)__ <br /> Refrigerant: Ice Blue Ice 0 None 0 Other 0 Comments: <br /> Custody Seals Ice 6mst ❑ Containers 0 ❑ <br /> None Comments: <br /> C <br /> lnfacO.Yes Fintact?Ye' 0 s 0 No 01 <br /> All samples received? Ye Noo All samples containers intact? Ye NoO Description(s)match COC? Ye 0 0 <br /> COC Received Emissivity: Container:&Z-19 Thermometer ll):j: Daternme -7 ly-:t jdA- <br /> E S 0 NO Temperature:A--0L_@ --c I C -c Analyst init <br /> SAMPLE CONTAINERSLl <br /> 2 3 4 5 6 7 8 9 10 <br /> CIT GENERAL MINERAL]GENERAL PHYSICAL <br /> PT PE UNPRESERVED <br /> OT INORGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> P'r 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 /> ON <br /> PLA PHENOLICS OXYGEN <br /> 40m1 VOA VIAL TRAVEL BLANK <br /> 40ca1 VOA VLAL <br /> OT EPA 413.1,413.2,418.1 <br /> F*r ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 ml VOA VIAL-504 <br /> OT EPA 5081608/8080 <br /> QT EPA 515.1/8150 <br /> -QT EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> 100ml EPA 547 <br /> 100m1 EPA 531.1 <br /> OT EPA 548 <br /> QT EPA 549 <br /> QT EPA 632 <br /> -QT EPA 8015M <br /> _QT AMBER <br /> 8 OZ.JAR <br /> 32 OZ.JAR <br /> SOIL SLEEVE <br /> .PCB VIAL <br /> PLASTIC BAG <br /> FERROUS URON <br /> ENCORE <br /> Comments: <br /> Sample Numbering Completed By: j.7,W,44�1 Date/Time: peo6l <br /> A= Actual *1 C=Corrected [H:%DOCSIWP801LAS-DOCS\FORMS\SAMREC2.WPDI <br />