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BC LABORATORIES INC. SAMPLE RECEIPT FORM Rev.No.12 06/24108 Page�_ Of_ <br /> Submission#: CI°l " b 3 b0 C-I <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express'< UPS O Hand Delivery ❑ ice Chestg` None 0 <br /> BC Lab Field Service CJ Other Q(Specify) Box ❑ Other 0 (Specify) <br /> Refrigerant: lee Blue Ice❑ Norte C Other O Comments: <br /> Custody Seals Ice Chest❑ Containers I] Non�B Comments: <br /> Intact?Yes❑ No Intact?Yes 0 No D S�� <br /> All samples received? Yes No C All samples containers intact? Ye�No❑ Descript`ion(s)match COC Y Yea Np ❑ <br /> COC Received Emissivity• �C Container:I OtAr\ Thermometer ID: — Date/Time <br /> `E�YES ❑ IVO <br /> Temperature:A j' °C ! C °C \ Analyst wt <br /> I .. SAMPLE NUMBERS <br /> SAMPLE CONTAINERS 1 2 3 4 5 6 7 B s to <br /> QT GENERAL MINERAU GENERAL PHYSICAL <br /> PT PE UNPRESERVED <br /> T INORGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS <br /> 1 PT CYANIDE <br /> P'T NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 22i.N17�RATE 1 NITRITE <br /> PT TATAL`ORGANIC CARBON _ <br /> PTY OX W <br /> P"l CHEMICAL OXYGEN DEMAND <br /> PtA PHENOLICS _..._.� <br /> 40m1 VOA VIAL TRAVEL BLANK _ <br /> 40m1 VOA ViA.R. <br /> OT EPA 413.1,413.2,418.1 _ <br /> PT ODOR <br /> I I <br /> RADIOLOGICAL <br /> BACTERIOLOGICAI, <br /> 40 ail VOA VIAL-504 ^ - � - <br /> T EPA 5081608/8080 <br /> T EPA 51 S.1/8)50 _ <br /> T EPA 525 J <br /> T EPA 525 TRAVEL BLANK _ <br /> 100mI EPA 547 <br /> 100ml 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 /> 31 OZ JAR <br /> SOIL SLEEVE <br /> PCB VIAI, <br /> PLASTIC BAG <br /> FERROUS IRON <br /> ENCORE <br /> Comments: _ <br /> Sample Numbering Completed By:_ � DaterTime:—zaalp�� <br /> A=Actual I C=Corrected (H!4DOCSlWP00llA6 DOCSIFORMSISAM19 REG 2.WPDI <br />