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Tom Laboratories, Inc. <br /> momw Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1007291 Page 2 of 2 <br /> LABORATORIESBC INC, SAMPLE RECEIPT FORM Rev,No,12 06120j 08 Page- Of J- <br /> --------------------------------------------- .....------............... <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express* UPS 0 Hand Delivery 0 Ice ChestKL None 0 <br /> BC Lab Field SerVice 0 Other 0(Specify)_ Box 0 Other 0(Specify) <br /> Refrigerant: Ice\4 Blue Ice O None 0 Other 0 Comments: <br /> Custody Seals Ice Chest k Containers 0 None D Comments: <br /> Intact?Ye 40 0 Intact?Yes 0 Nom„ <br /> All samples received? YesZ'--Noo All samples containers intact? Yes No 0 Description(s)match COC? Yelf—N. 0 <br /> COC Received Emissivilly: -AL Thermometer to* 3 Container: AWL Datefrime <br /> :TI/to <br /> YES 0 NO Temperature: I C C Analyst snit lot <br /> P1 F WIMRFRA <br /> SAMPLE CONTAINERS 2 3 4 1 a a 7 a 5 10 <br /> Or GENERAL MINERALJ GENERAL PHYSICAL <br /> PT PE UNPMER%" <br /> QT INORGANIC(,HEIIICAL METAIA <br /> PT INORGANIC CHEM ICAL METALS <br /> PTCYANIDE <br /> PT NITROGEN FORMS <br /> PTTOTAL SULFIDE <br /> UL NITRATE!NITRITE. <br /> PT TOTAL ORGANIC CAMON <br /> PT TOX <br /> PT CHEMICAL OXYQEN QEKAKD <br /> M PHENOLICS <br /> 40ml VOA VIAL TRAVEL BLANK <br /> 40.1 VOA VIAL AI i r 1 y l '9 <br /> OT EPA 4111,413.2.418.1 <br /> Ejanog <br /> RAIC.Al, <br /> 40 IVOAVIAL-504 <br /> QT EPA 5691603/8080 <br /> QT EPA 515.1181511 <br /> JQJ EPA$25 <br /> OT EPA 525 TRAVEL ELANN <br /> I00wl-EPA 547 <br /> 100ml EPA 531 1 <br /> OT EPA 548 <br /> OT EPA W <br /> OT EPA 637 <br /> OT EPA$015H <br /> QTAMBER <br /> 8 OL JAR <br /> 32 OZ JAa <br /> SQ?LSLE Qj <br /> PCB VIAL <br /> PLASTIC BAC <br /> FERRO SIRON <br /> ENCORE <br /> Comments: <br /> Sample Numbering Completed By: (I LVDatalTime: <br /> -7 '5/5- <br /> A=Artual I C=Corrected jH:1D0GS1WP8MI-A8_WCWORMS%SAMREC7 WPOI <br /> The results in this report apply to the samples analyzed in accordance with the chain of custody document.This analytical report must be reproduced in its entirety. <br /> All results listed in this report are for the exclusive use of the submitting party BC Laboratories,Inc.assumes no responsibility for report alteratiorl separation,detachment or third party interpretation <br /> 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.bclabs.com Page 4 of 32 <br />