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Inc. <br />Environmental Testing Laboratory Since 1949 <br />Chain of Custody and Cooler Receipt Form for 1710606 Paoe 2 of 2 <br />BC LABORATORIES INC. <br />COOLER RECEIPT FORM <br />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 Iq None ❑ Box ❑ <br />Other ❑ (Specify) <br />FREE LIQUID <br />YES NO ❑ <br />/ S <br />Refrigerant: Ice 19 Blue Ice ❑ None ❑ <br />Other ❑ Comments: <br />Custody Seals IGe4Chest ❑ Containers ❑ :: <br />s c <br />None X Comments: <br />All samples received? Ye&10 No ❑ All samples containers intact? Ye No ❑ Description(s) match COC? Yeso No 0 <br />COC Received Emissivity: Q • 9 <br />9 YES ❑ NO Tem erature: (A) <br />Container: Thermometer ID: <br />• "C / (C I • 'C <br />D1ate/Time �C 7 y <br />Analyst Ink <br />SAMPLE CONTAINERS <br />1 2 <br />SAMPLE NUMBERS <br />3 4 5 6 7 <br />8 9 10 <br />T PE UNPRES <br />4oz / 8oz / Met PE UNPRES <br />20. Cr" <br />T INORGANIC CHEMICAL METALS <br />INORGANIC CHEMICAL METALS 4oz / Son: 116oz <br />PT CYANIDE <br />PT NITROGEN FORMS <br />PT TOTAL SULFIDE <br />2m NITRATE / NITRITE <br />PT TOTAL ORGANIC CARBON <br />PT CHEMICAL OXYGEN DEMAND <br />PW PHENOLICS <br />40.11 VOA VIAL TRAVEL BLANK <br />40mi 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 515.1/8150 <br />T EPA 525 <br />T EPA 525 TRAVEL BLANK <br />40m1 EPA 547 <br />40.11 EPA 531.1 <br />-_ <br />8oz EPA 548 <br />T EPA 549 <br />T EPA 8015M <br />T EPA 8270 <br />8oz / 16oz /320z AMBER <br />8oz / 16oz / 32oz JAR <br />SOIL SLEEVE <br />PCB VIAL <br />PLASTIC BAG <br />TEDLAR BAG <br />FERROUS IRON <br />ENCORE <br />SMART <br />KIT <br />- <br />- <br />SUMMA <br />CANISTER <br />Comments: <br />LA <br />Sample Numbering Completed By <br />A = Actual / C = Corrected <br />Date/Time: Isav <br />Ia:IWPDoaw..dP.rreontna <br />21 o5/2312016 <br />MMFoawslsAMEC.. 201 <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 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 />