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M� Laboratories Inc. <br />Environmental Testing Laboratory ine1 <br />949 <br />Gnaln of Custody and GOOIer Kecelot Form for 1714656 Paae 2 of 2 <br />rnnt CR d r•FIOT FnRM Paae I _ t/t 1 <br />6V LADURAr Vr —1— <br />---- <br />Submission #: • 1L{ <br />SHIPPING INFORMATION <br />SHIPPING CONTAINER <br />FREE LIQUID <br />Fed Ex ❑ UPS ❑ Ontrac ❑ Hand Delivery ❑ <br />Ice Chest M None ❑ Box ❑ <br />YE NO ❑ <br />BC Lab Field Service I& Other ❑ (Specify) <br />Other ❑ (Specify) <br />NV i S <br />Refrigerant: Ice's Blue Ice ❑ None ❑ Other ❑ <br />Comments: <br />Custody Seals <br />1¢e'Chesi Q <br />No n <br />Containers O <br />mace Yes n No n <br />No <br />IW Comments: <br />All samples received? Yes No ❑ All samples containers intact? Yes No ❑ Description(s) match COC? Yes TjNo ❑ <br />COC Received Emissivity: 0 Container: <br />I y Thermometer ID: DateTme _tf <br />9 YES ❑ NO Tem erature: (A) ib <br />°C / (C ) °C Analyst !nit <br />- <br />SAMPLE NUMBERS <br />SAMPLE CONTAINERS <br />7 2 3 <br />4 5 6 7 <br />a 9 10 <br />T PE UNPRES <br />4oz / 8oz / 16oz PE UNPRES <br />zoz Cr, <br />T INORGANIC CHEMICAL METALS <br />INORGANIC CHEMICAL METALS 4oz /8oz / 16oz <br />--j <br />PT CYANIDE <br />PT NTTROGEN FORMS <br />PT TOTAL SULFIDE <br />2oz. NITRATE / NITRITE <br />PT TOTAL ORGANIC CARBON <br />PT CHEMICAL OXYGEN DEMAND <br />PLA PHENOLICS <br />40mi VOA VIAL TRAVEL BLANK <br />40m1 VOA VIAL <br />T EPA 1664 <br />PT ODOR <br />RADIOLOGICAL <br />BACTERIOLOGICAL <br />40 mi VOA VIAL -504 <br />T EPA 5081608/8080 <br />T EPA 515.iB150 <br />T EPA M <br />T EPA 52S TRAVEL BLANK <br />40mt EPA 547 <br />40.1 EPA 531.1 <br />Boz EPA 548 r <br />T EPA 549 <br />T EPA 8015M <br />T EPA 8270 <br />Saz / 16oz t 32oz AMBER <br />8oz/16oz/32oz JAR <br />SOIL SLEEVE <br />PCB VIAL <br />PLASTIC BAG <br />TEDLAR BAG <br />FERROUSIRON <br />ENCORE <br />SMART KIT <br />SUMMA CANISTER <br />Comments: <br />Sample Numbering Completed By: DatetTime: R- zt ost2�tzots <br />A = Actual I C = Corrected ISAWPeoc\WadPereallPa 00C5\FORMSISpMREGev 201 <br />11 <br />The results in this report apply to the samples analyzed in accordance with the chain ojcusiody 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 alteration, separation, detachment or third party interpretation. <br />Report ID: 1000611630 4100 Atlas Court Bakersfield, CA 93308 (661) 327-4911 FAX (661) 327-1918 www.bclabs.com Page 4 of 12 <br />