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BC LABORATORIENIA. I dq IQSAMPLE RECEIPT FORM Rev.No.12 06/24/08 Page_Of <br /> Submission <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express ❑ UPS ❑ Hand Delivery ❑ Ice Chesty' None ❑ <br /> BC Lab Field Service Other❑(Specify) Box ❑ Other ❑ (Specify) <br /> Refrigerant: Ice Blue Ice❑ None❑ Other❑ Comments: <br /> Custody Seals Ice Chest d . Containers O Non Comments: <br /> Intact?:Yes❑ o❑ Intact?Yes No ❑ <br /> _] <br /> All samples received? Yes/No❑ All samples containers intact? Yes/ No❑ Description(s)match COC? Yes 0JN0 ❑ <br /> OC Receive Emissivity: 0 Container; Thermometer ID: 1hrilN Date/Time eq-2—DiI <br /> /C <br /> YES ❑ OOoh° <br /> Temperature:A �� °C / C C Ct ., Analyst Init J tJi1) <br /> SAMPLE NUMBEIRS <br /> SAMPLE CONTAINERS 2 3 4 5 6 7 8 s 10 <br /> OT GENERAL MINERAL/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 <br /> PT TOTAL ORGANIC CARBON <br /> PT TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> PtA PHENOLICS <br /> 40ml VOA VIALiTRAVEL BLANK <br /> 40ml VOA VIAL ) ) l ) 1 1 ) 1 ) 1 ) 1 ) l 1 ) <br /> T EPA 413.1 413.2 418.1 <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 /> 100ml EPA 547 <br /> 100m]EPA 531.1 <br /> T EPA 548 <br /> T EPA 549 <br /> T EPA 632 <br /> T EPA 8015M <br /> T AMBER <br /> 8 O7,JAR <br /> 32 OZ.JAR <br /> SOIL SLEEVE <br /> PCB VIAL <br /> PLASTIC BAG <br /> FERROUSIRON <br /> ENCORELi <br /> Comments — V <br /> Sample Numbering Completed By: Date/Time: NO <br /> A=Actual / C=Corrected [H:\DOCS\WP80\LAB_DOCS\FORMS\SAMREC2.WPD] <br />