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Laboratories Inc. I <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1315967 Page 2 of 2 <br /> —i—ca Im'. COOLER RECEIPT FORM Rev.No.15 07{01/13 Page Of 1 <br /> submission #: >-" !s & <br /> SHIPPING INFORMATION SHIPPING CONTAINER FREE LIQUID <br /> 'ederal Express ❑ UPS❑ Hand Delivery Ice Chest-15' None ❑ Box ❑ YES ❑ NO ❑ <br /> lC Lah Field Service J5:" Other❑{Specify) Other ❑(Specify) <br /> iefrigerant: Ice Er Blue Ice❑ None❑ Other❑ Comments: <br /> ustody Seats iceChest Cf Containers=C]r'i. None Comments: <br /> Antaril <br /> II samples received? Yes No❑ All samples containers intact? Yes No-❑ Description(s)match COC? Yes❑ No <br /> COC Received Emissivity: 0.G(R Container._t%- Pc Thermometer tD: 20 7Date�me '.3C•!3 2130 <br /> -'YES ❑ IVO <br /> Temperature: (A) J,y °C / IC I I.� `C Analyst InitLl_� <br /> SAMPLE NUMBERS <br /> SAMPLE CONTAINERS <br /> 1 2 3 4 5 6 7 a 9 10 <br /> 'GENERAL MINERAL GENERAL <br /> PE UNPRESERVED <br /> ',INORGANIC CHEMICALMETALS <br /> INORGAMC CHEMICAL METALS <br /> CYANIDE <br /> NITROGEN FORMS <br /> TOTAL SULFIDE <br /> .NITRATE 7 NITRITE <br /> TOTAL ORGANIC CARBON <br /> Tox <br /> CHEMICAL OXYGEN DEMAND <br /> PHENOLICS <br /> L)VOA VIAL TitAVEL BLANK Z <br /> J VOA VIAL <br /> EPA 413.E all al8.i <br /> 3DOR <br /> HOLOGICAL <br /> MRIOLOGICAL <br /> d VOA VIAL.SO4 <br /> EPA 5081G40/0060 <br /> EPA 51S. &1.56 <br /> :PA 5115 <br /> U'A S'S TRA VEL BLANK <br /> if EPA 547 II <br /> d EPA 53LI <br /> :PA 540 <br /> :PA 541 <br /> :PA CO. <br /> :PA eau-M <br /> MBER <br /> JAR <br /> JAR <br /> SLEEVE <br /> ytAL <br /> TIC BAG <br /> ,OLM IRON <br /> IRE <br /> LT IRT <br /> nn Cacister <br /> onts� <br /> t Numbering Completed By: Date tme: <br /> etual / C - Corrected .rtstl(I <br /> The results in this report aPPY to the 1 lanalyzed in accordance with the chain of custody document.This analytical report must be reproduced in its entirety. <br /> P samples ana <br /> All results listed to 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 36 <br />