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- Laboratoriesqc. <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1103965 Page 2 of 2 <br /> ec LABORATORIES INC. SAM LE RECEIPT FORM Rev.No.12 0684/08 Pa a Of <br /> Submission #: 11'�w L1C9S <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express ❑ UPS❑ Hand Delivery ❑ Ice Chest None ❑ <br /> BC Lab Field Service Qther❑(S,peclfy) Box ❑ Other O..(Specify) <br /> Refrigerant: ice Blue,ce❑ Nt7ne 1=1; ',.>.Q(tler Q Gornments: <br /> Custody Seals Ice Ctiest'❑ Cgjtal�er3:'C� Nan Comments: <br /> Intact?Yes No 0Intact!Yest�'cNo <br /> All samples received?' Ye No Q r5 Allarrlies containers intact? Yese No O Description(s)match COC? Yey(PNo ❑ <br /> COC Received � �x Ivlty D.`�3 Container: Thermometer iD: 114? DatelTime 3-L b-11 <br /> 'YES ❑ �fl �_ = :. _ __ alltD <br /> a4 : £sit4re A •� °C t C I�� eC Analyst ioit jti Q <br /> RAAAPI <br /> r 4'in",t cy s sem. _ <br /> SEq NUTS a 4 2 7 t S 6 7 6 9 IO <br /> OT GENERAL Mild <br /> PT PE IRVPR�SE2VEt �xy-°^ <br /> T INORGALYIC CE[��i4t1��..,' <br /> PT(NORGAN[C` HLA4[. ASS <br /> PT CYANIDE ,'#'tu a' - <br /> PT NITEGGEN P.ORMS_' <br /> PT TOTAL SrJLRiDE-,ar't <br /> o s <br /> ]a.NITRATE!Nt. !'••-y"ae`' <br /> PT TOTAL ORGAN[Cr' ':l) vc <br /> PT TOX Y. £� <br /> PT CHEMICAL 0X3CENMEM <br /> PIA PHENOLICS. Al <br /> ', 0 y <br /> .. ff ,cq <br /> 40ml VOA VIAL TICAB •#i. <br /> 40-1 VOA VIAL <br /> QT ERA 413.1 417.1 418 KW- .4M$ •.- <br /> " 3 <br /> PT ODOR <br /> x <br /> iWWOLOGICeU;:'s <br /> BAC:6ERIOL©':.-. .a*`•T <br /> TEPA��Ia"` <br /> T EeIoQ 11 <br /> n± <br /> }s. <br /> T EP.td4 <br /> T EPX:63'I <br /> 4 K <br /> 3107.JAkF - <br /> x _•a <br /> SOILStEEKE <br /> PCb VIAL " l <br /> PLASTIC BAG' <br /> FERRO SERON <br /> . <br /> ENCORE <br /> Comments' } <br /> Sample Numbering Completed By: Date'rTime• <br /> A=Actual t C=Corrected IK:%000S%WP81AUie oocstSd <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 alteratim l 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 18 <br />