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u <br />u <br />0 <br />r. <br />r <br />L, <br />i <br />rI <br />r <br />Laboratories Inc. , <br />Environmental Testing Laboratory Since 1949 <br />Chain of Custodv and Cooler Receint Form for 1118171 Pane 2 of 2 <br />3C LABORATORIES INC. SAMPLE RECEIPT FORM Rev. No. 12 06/2410® Page _ Of/— <br />f _Submission <br />Submission#: <br />SHIPPING INFORMATION <br />Federal Express ❑ UPS ❑ Hand Delivery ❑ <br />BC Lab Field Service Jr'a''' Other ❑ (Specify) <br />9HIPPING CONTAINER <br />Ice Chest2f None ❑ <br />Box ❑ Other ❑ (Specify) <br />Refrigerant: Ice Blue IC e ❑ None ❑ Other ❑ Comments: <br />Custody SealsIce Chest ElContainers None/V1 Comments: <br />[intact? Yes ❑ No I", -tact? Yes No ❑ <br />All samples received? Y No ❑ All samples containers Intact? Yes o ❑ Description(s) match COC o ❑ <br />COC Received Emissivity: }( i Container: NlbA Thermometer ID: 1-1-1 Daternme <br />� <br />WEA4U <br />Pd YES ❑ NO Temperature: A S A °C I C � � 'C Analyst Init 4l;;� <br />SAMPLE CONTAINERS 1 2 3 4 5 6 7 a 9 10 <br />OT GENERAL MINERAL! GENERAL PHYSICAL <br />PT PE UNPRESERVED <br />T INORGANIC CHEMICAL METALS <br />PT INORGANIC CHEMICAL METALS <br />PT CYANIDE <br />PT NITROGEN FORMS <br />PT T TAL SULFIDE <br />los NITRATE / NITRITE <br />PT TOTAL ORGANIC CARBON <br />PT TOX <br />PT CHEMICAL OXYGEN DEMAND <br />. <br />PtA PHENOLICS <br />40.1 VOA VIAL TRAVEL BLANK <br />1 1 l I 1) 1 I 1 I I 1 1 1 1 <br />. <br />40.1 VOA VIAL. <br />T EPA 413.1 413.2 418.1 <br />PT ODOR <br />RADIOLOGICAL <br />BACTERIOLOGICAL <br />40.1 VOA VIAL 504 <br />T EPA 508/608/8080 <br />T EPA 511IM150 <br />T EPA 525 <br />T EPA 525 TRAVEL BLANK <br />100.1 EPA 547 - <br />100.1 EPA 531.1 <br />T EPA 548 <br />T EPA 549 <br />T EPA 632 <br />QT EPA 8015 <br />T AMBER <br />8 OZ JAR <br />32 OZ JAR <br />SOIL, SLEEVE <br />PCB VIAL <br />PLASTIC BAG <br />FERROUS IRON <br />ENCORE <br />Comments: <br />Sample Numbering Completed By: Date/Tlme: <br />A = Actual I C = Corrected p1:MiocS6NPaou.Ae pOCS%FORMSISAMRECLWP01 <br />The results in this report apply to the samples analyzed in accordance with the chain ofcustody 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 18 <br />