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® Laboratories Inc. <br /> ® Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1402120 Page 2 of 3 <br /> BC LABORATORIES <br /> ►NC. COOLER RECEIPT FORM Rev.No.15 07101M Page_Of <br /> Submission#: - D SHIPPING CONTAINER FREE LIQUID <br /> SHIPPING INFORMATION Ice Chest- None 11 Box 11 YES ❑ NO ❑ <br /> Federal Express 13 UPS 13Hand Delivery Other ❑(Specify) <br /> BC Lab Field Service cX Other❑(Specify)______---- <br /> Other❑ Comments: <br /> ' Refrigerant: Ice Blue Ice❑ None❑ <br /> Custody Seatsce Ches>t] Containers:❑, None�C Comments: <br /> i <br /> Alles containers intact? Ye;AD No❑ Description(s)match COC? Yes�No ❑ <br /> All samples received? Yes� No❑ samples D_ Zr-t�V <br /> Emissivity: Container: f Thermometer ID: 'J�._. Date/rime I <br /> COC Received 2 ,C Analyst snit <br /> j ES 0 NO Temperature: (A IAC 1 (C 1_�— <br /> I <br /> SAMPLE NUMBERS ,, <br /> 1 'S 9 10 <br /> t 2 I <br /> SAMPLE cONTAINERS 3 4 5 6 S <br /> ! <br /> T GENERAL A'IINERAIJ GENERAL <br /> PT PE UNPRESERVED <br /> T INORGANIC CI-HCAL MATAS's O <br /> PT INORGANIC CIiEhIICAL METALS <br /> pT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> 2oz NITRATE/NITRTTE <br /> PT TOTAL ORGANIC CARBON <br /> PT TOR <br /> PT CIffit'IICAL ORYGEN DEMAND <br /> PtA pBENOLICS <br /> 40m1 VOA VIAL TRAVEL BLANK t I t t t t t t t I <br /> t I t t t t <br /> 40.1 VOA VIAL <br /> T EPA 413.1 413. 418.1 <br /> PT ODOR <br /> RADIOLOGICAL IFIk� 1 N <br /> BACTERIOLAGICAL 1 <br /> 40 ail VOA VIAL"504 1 <br /> T EPA 508/6088080 <br /> T EPA 515.1/8150 — - —- _— <br /> T EPA SZS ' <br /> T EPA 525 TRAVEL BLANK <br /> 100m1 EPA 547 <br /> 100ad EPA 531.1 <br /> T EPA 548 <br /> OT EPA 549 A� <br /> BPA 632 "( t°1._. rYoc <br /> TEPA8015M <br /> T AMBER C+ T <br /> 8 OZ.JAR <br /> 32 OZ.JAR <br /> SOIL SLEEVE <br /> PCB VIAL <br /> PLASTIC BAG <br /> FERROUS IRON <br /> 'NCORE <br /> ,ART Krr <br /> 'MR Canister <br /> ants: Date/Time. 3l0 <br /> u.._�.......,r,_nleted By: Is:\MVDOlSIWordPertectlLA6 DD(StPORMSl6AMREG751 <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.bclabs.com Page 4 of 43 <br />