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Laboratories Inc. <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1315968 Page 2 of 2 <br /> UL;LAOUKr4IUKItS ING. COOLER RECEIPT FORM Rev.No.15 07101/13 Page I Of <br /> Submission #: ! <br /> SHIPPING INFORMATION SHIPPING CONTAINER FREE LIQUID <br /> Federal Express ❑ UPS❑ Hand Deliverytce Chest-FP None ❑ Box ❑ YES ❑ NO [IBC Lab Feld Service '� Other❑(Specify) Other 0(Specify) <br /> Refrigerant: Ice 2r Blue Ice 0 None 0 Other 0 Comments: <br /> :;ustody Seals Ice'Ch'est 0 Containers O• None Comments: <br /> ail samples received? Yes No O All samples containers intact? Y..X No❑ Description(s)match COC? Yes❑ No <br /> COC Received Emissivity: 0-93_ Container. Off- pc Thermometer to: 20 ! Date/Time -7.;;c•13 ZI51 <br /> ' 'YES ❑ NO <br /> Temperature: (A 1--�.�°C / (C °C Analyst Ink�_�_ <br /> SAMPLE NUMBERS <br /> SAMPLE CONTAINERS <br /> l 2 3 4 5 D 7 8 9 7D <br /> T GENERAL MINERALJ GENERAL <br /> T PE UNPRESERVED <br /> )T INORGANIC CHEMICAL METALS rr <br /> T INORGANIC CHEMICAL METALS 1...- <br /> T CYANIDE <br /> .p NITROGEN FORMS <br /> IT TOTAL SULFIDE <br /> ot_NITRATE/NITRITE <br /> TTOTAL ORGANIC CARBON <br /> T TOX <br /> T CHEMICAL O).'YGEN DEMAND <br /> to PHENOLICS <br /> Dml VOA VIAL TRAVEL,BLANK <br /> Dml VOA VIAL + I I I <br /> iT EPA 413.1.413?316.) <br /> T ODOR <br /> ADIOLOGICAL <br /> ACTERIOLOGICAL <br /> )rat VOA VIAL SM <br /> T EPA 3UMB/8064 <br /> T EPA 515XHISO <br /> T EPA 575 <br /> TEPA 525 TRAVEL BLANK <br /> (Dail EPA 547 <br /> 10.1 EPA 531-t <br /> T EPA 546 <br /> T EPA 544 <br /> T EPA&P <br /> - <br /> T EPA BDI-M <br /> T AMBER <br /> OZ JAR <br /> OZ.JAR <br /> )IL SLEEVE <br /> :B VIAL <br /> .ASTIC BAG <br /> :RROUS[RON <br /> 4CORE <br /> MART IGT <br /> initta Canister <br /> ttment. <br /> nPle Numbertng Completed By: /J,.r: DatelTFme: <br /> Actual I C= Corrected Isnmynocstwm.m°.lo�nuo oocs+Fannns+snnnnectsl <br /> with the chain o custody document.This anal ical report must be reproduced in its entirety. <br /> The results in this report apply to the samples analyzed in accordance f dy yt Po <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 /> 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.bciabs.com Page 4 of 26 <br />