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Environmental Testing Laboratory Since 1949 <br />Chain of Custodv and Cooler Receiot Form for 1717141 Paae 2 of 2 <br />sc LABORATORIES INC. COOLER R CEIPT FORM Page Of <br />Submission #: <br />SHIPPING INFORMATION <br />Fed Ex ❑ UPS ❑ Ontrac ❑ Hand Delivery ❑ <br />BC Lab Field Service ZSI Other ❑ (Specify) <br />SHIPPING CONTAINER <br />Ice Chest ® None ❑ Box ❑ <br />Other ❑ (Specify)_-- <br />FREE LIQUID <br />YES ❑ NO ❑ <br />W / S <br />Refrigerant: Ice 9 Blue Ice ❑ None ❑ Other ❑ Comments: <br />Custody SealsItf <br />Cheet ❑ <br />Iii <br />Containers El <br />None Zai Comments: <br />All samples received? Yes No ❑ All samples containers intact? Yes No ❑ Description(s) match COC? Ye No ❑ <br />COC Received Emissivity: a Container: )le,,A Thermometer ID: y2Q Date/Time (] <br />® YES ❑ NO Temperature: (A) "2— °C / (C ) °C Analyst Ink <br />• SAMPLE NUMBERS <br />SAMPLE CONTAINERS - <br />t 2 3 4 0 B 7 B 9 to <br />QT PE UNPRES <br />4oz I Boz 116oz PE UNPRES <br />2oz Cr" <br />T INORGANIC CHEMICAL METALS <br />INORGANIC CHEMICAL METALS 4oz /8oz / 16Dz <br />PT CYANIDE <br />PT NITROGEN FORMS <br />PT TOTAL SULFIDE <br />2= NITRATE / NITRITE <br />PT TOTAL ORGANIC CARBON <br />PT CHEMICAL OXYGEN DEMAND <br />PtA PHENOLICS <br />40m[ VOA VIAL TRAVEL BLANK ° <br />40.1 VOA VIAL <br />r <br />T EPA 1664 <br />PT ODOR <br />RADIOLOGICAL <br />BACTERIOLOGICAL <br />40 mt VOA VIAL. 504 <br />T EPA 508/6088080 <br />T EPA 515.18250 <br />T EPA S25 <br />T EPA 525 TRAVEL BLANK <br />40m] EPA 547 <br />40mi EPA 531.1 <br />Roz EPA S49 t <br />T EPA 549 <br />T EPA 8015M - <br />T EPA 8270 <br />Boz/16oz/32m AMBER <br />Boz 116oz 132= JAR <br />SOILSLEEVE <br />PCB VIAL <br />PLASTIC BAG <br />TEDLARBAG <br />FERROUS[RON r <br />ENCORE <br />SMART KIT <br />SUMMA CANISTER <br />Comments - <br />.— <br />Sample Numbering Completed By: Date/Time: aer 22 o-23MOIS <br />A = Actual / C = Corrected ts:twrD,aw°,dr°nama -Docswamstsamaec-201 <br />v <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 alteration, separation, detachment or third parry interpretation. <br />Report ID: 1000621887 4100 Atlas Court Bakersfield, CA 93308 (661) 327-4911 FAX (661) 327-1918 www.bclabs.com Page 4 of 12 <br />