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Laboratories, Inc. <br />Environmental Testing Laboratory Since 1949 <br />Chain of Custodv and Cooler Receiot Form for 1710606 Paae 2 of 2 <br />BC LABORATORIES INC. COOLER RECEIPT FORM Page O <br />Submission #: / <br />SHIPPING INFORMATION <br />Fed Ex ❑ UPS ❑ Ontrac ❑ Hand Delivery ❑ <br />BC Lab Field Service 14 Other ❑ (Specify) <br />SHIPPING CONTAINER <br />Ice Chest 4Q None ❑ Box ❑ <br />Other ❑ (Specify) <br />FREE LIQUID <br />YES NO ❑ <br />/ S <br />Refrigerant: Ice 1$i Blue Ice ❑ None ❑ Other ❑ Comments: <br />Custody Seals [ce Chest ❑ _ <br />Contameis ❑ . <br />None J4 Comments: <br />All samples received? Yeakk No ❑ All samples containers intact? Ye No ❑ Description(s) match COC? Yew No ❑ <br />COC Received Emissivity: 9. Container: Thermometer ID: Date/Time <br />191 YES ❑ NO Temperature: (A) "C / (C ! °C Analyst Init <br />SAMPLE NUMBERS <br />SAMPLE CONTAINERS <br />1 2 3 4 5 6 7 8 a 10 <br />T PE UNPRES <br />4oz / 8oz 116oz PE UNPRES <br />20Z Cr*, <br />T INORGANIC CHEMICAL METALS <br />INORGANIC CHEMICAL METALS 4oz / Soz / 160z <br />PT CYANIDE <br />PT NITROGEN FORMS <br />PT TOTAL SULFIDE <br />2oz. NITRATE I NITRITE <br />PT TOTAL ORGANIC CARBON <br />PT CHEMICAL OXYGEN DEMAND <br />P(A PHENOLICS <br />40ml VOA VIAL TRAVEL BLANK <br />40ml VOA VIAL <br />T EPA 1664 <br />PT ODOR <br />RADIOLOGICAL <br />BACTERIOLOGICAL <br />40 ml VOA VIAL- 504 <br />T EPA 508160818080 <br />T EPA 515.118150 <br />T EPA 525 <br />T EPA 525 TRAVEL BLANK <br />40ml EPA 547 <br />40ml EPA 531.1 <br />- - <br />8oz EPA 548 <br />T EPA 549 <br />T EPA 8015M <br />T EPA 8270 <br />8oz / 16oz I32cz AMBER <br />8oz / 16oz / 32oz JAR <br />SOIL SLEEVE <br />PCB VIAL <br />PLASTIC BAG <br />TEDLAR BAG <br />FERROUS IRON <br />ENCORE <br />i <br />SMART KIT <br />SUMMA CANISTER <br />Comments: LA <br />Sample Numbering Completed By: Date/Time: Rev 21 05/23/7016 <br />A = Actual / C = Corrected IS:tWPOo6WardParf¢tAAkDDCMRMS1SAMREGav 201 <br />n <br />The results in this report apply to the samples analyzed in accordance with the chain of custody document. This analytical report must he 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 alteration, separation, detachment or third party interpretation. <br />Report ID: 1000598131 4100 Atlas Court Bakersfield, CA 93308 (661) 327-4911 FAX (661) 327-1918 www.bclabs.com Page 4 of 12 <br />