Laserfiche WebLink
d <br />n <br />D <br />H <br />Laboratories Inc. ; <br />Environmental Testing Laboratory Since 1949 <br />Chain of Custody and Cooler Receipt Form for 1118171 Page 2 of 2 <br />3C LABORATORIES INC. SAMPLE RECEIPT FORM Rev. No. 12 06124/08 Pae Of/— <br />f _Submission <br />Submission#: <br />SHIPPING INFORMATION <br />Federal Express ❑ UPS ❑ Hand Delivery ❑ <br />BC Lab Field Service [� Other ❑ (Specify) <br />HIPPING CONTAINER <br />Ice Chest None ❑ <br />Box ❑ Other ❑ (Specify) <br />Refrigerant: Ice Blue Ice ❑ None ❑ Other ❑ Comments: <br />Custody Seals 'Ice Ghest ❑ Coritamers a. None Comments: <br />In ct?Yes N Intact?Yes 6 No ❑ <br />All samples received? Y No ❑ All samples containerso intact? Yes ❑ Description(s) match COC o 11COC <br />Received Emissivity: 019-f Container: �jItCk Thermometer ID: f111 Date/Time <br />Pi YES No Temperature: A `, °C / C "C Analyst Init<.t F.'• D <br />SAMPLE CONTAINERS 1 2 3 4 5 e 7 s s io <br />OT GENERAL MINERAL/ GENERAL PHYSICAL <br />PT PE UNPRESERVED <br />T INORGAMC CHFAMCAL METALS <br />PT INORGANIC cfmTvnCAL METALS <br />PT CYANIDE <br />PT MTROG N FORMS <br />PT TOTAL SULFIDE <br />2m N1TRATE I NITRITE <br />PT TOTAL ORGANIC CARBON <br />PT TOX <br />PT CHEMICAL OXYGEN DEMAND . <br />PtA PHENOLICS <br />40.1 YOA VIAL TRAVEL BLANK <br />t l 1 ( l l 1 ) 1 1 1 1 1 l 1 <br />40ml VOA VIAL, <br />T EPA 413.1 413.2 418.1 <br />PT ODOR <br />RADIOLOGICAL <br />BACTERIOLOGICAL <br />40 .I VOA VIAL• 504 <br />T EPA 508160818080 <br />T EPA 515.1/8150 <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 />TEPA SO LSM <br />T AMBER <br />8 OZ JAR <br />32 OZ JAR <br />SOIL SLEEVE <br />PCB VIAL <br />PLASTIC BAG <br />FERROUS MON <br />ENCORE <br />Comments: <br />Sample Numbering Completed By: DatelTime: <br />A = Actual / C = Corrected IH:10oC61WP801LA6 00C8LFORMStSAMREC2.WPOl <br />I The results /n this report apply to the samples analyzed in accordance with the chain ,f custody documenl. This analytical report must be reproduced in its entirety. <br />All results listed in this report are for the exclusive use of the submitting parry. BC Laboratories, Inc. assumes no responsibility for report alteration, separation, detachment or third parry interpretation. <br />4100 Atlas Court Bakersfield, CA 93308 (661) 327-4911 FAX(661)327-1918 www.bclabs.com Page 4 of 18 <br />