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® Laboratoraes Inc. <br /> ® Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1402121 Page 2 of 3 <br /> COOLER RECEIPT FORM i <br /> .ABOBpTORIES INC,a�al FREE LIO.UID <br /> ( Vv SHIPPING <br /> CONTAINERBox Q YES 13 NO ❑ <br /> )mission"#*1 None (3 <br /> SHIPPING INFORMATION Ice Chest-;a <br /> Hand Delivery Other Q(Specify) <br /> feral Express Q UPS 13 Other[3(SPecify)_. <br /> Lab Feld Service <br /> Blue Ice❑ None❑ <br /> Other Q Comments: <br /> efrigerant: Ice None C� Comments: <br /> Containers❑ <br /> stody Seals Ice Chest'O COC? Yes>� No ❑ <br /> ', No 0 _ Descriptio, match 2„rrn <br /> All samples containers intact? Yes Date/time 2 +-✓V <br /> 1 samples received? Y es; N00 tmssiv'rtY: _ n Thermometer 1D:_ -- <br /> l�l_-1.5=1_ Container: Yom— _ �atyst tnit <br /> E +ri <br /> COC Received l c 1 g.c ) I <br /> ES ❑NQ Temperature: l A).� ; •SAyIPLE NUMBERS <br /> 10 <br /> 7 S <br /> s <br /> 3 4 <br /> 5 6 <br /> SAMPLE CONTAINERS <br /> 2 <br /> T GENERAL I�NERAId GENERAL <br /> !TPEUNPRE=VED <br /> T INORGANIC CBEW— ALS <br /> TATS <br /> PT INORGANIC <br /> PT CYANIDE . <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 2oz NITItATB/T`T1T�E <br /> rr TOTAL ORGANIC CARBON . <br /> PTTOX <br /> PT CRSNIICAL OXYGEN DEMAND t t t t t t <br /> t t c t <br /> nA PHENOLICS t t t t <br /> BLASSA t t t t t t <br /> 40mlvoAVIALT��' � <br /> 40m1 VOA VIAL <br /> TEPA 413.1 413 <br /> 418.1 t <br /> PTO <br /> 1 RADtOLOG1CAL <br /> BACTERIOLOGICAL <br /> 40 ml VOA VIAL 504 <br /> T EPA 5081608/8080 <br /> EPA Si5.L81S0 . <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> IOOmI EPA 547 <br /> 100.1 EPA 531.1 _ <br /> T EPA 548 <br /> TEPA 549 <br /> EPA 632 <br /> TEPA 8015M . <br /> T AMBER <br /> 8 OZ.JAR <br /> 32 OZ.JAR <br /> SOIL SLEEVEf <br /> pCB VIAL <br /> pLASTIt BAG <br /> pERROUS IRON <br /> NCORE <br /> `ART KTT <br /> 'me Canister 2310 dPerk�atJle OOC.8tF08MStSAMHECt! <br /> t Datermn a,. 1s:XM90O�W. <br /> ants: <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 /> 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.bciabs.com Page 4 of 28 <br />