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111M -- <br /> Laboratories Inc. <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1621369 Page 2 of 2 <br /> BC LABORATORIES INC. COOLER RECEIPT FORM Page Of <br /> Submission #: <br /> SHIPPING INFORMATION SHIPPING CONTAINER FREE LIQUID <br /> Fed Ex ❑ UPS❑ Ontrac❑ Hand Delivery ❑ Ice Chest W None D Box ❑ 'YES-)Q NO ❑ <br /> BC Lab Field Service Other❑(Specify) Other Specify) W%)f S <br /> Refrigerant: Ice Blue Ice D None D Other❑ Comments: <br /> Custody Seals Ice Chest❑ Gontamera O. : None Comments: <br /> lineAll samples received? Yes No❑ All samples containers intact? Yes No O Description(s)match COC? Yes No ❑ <br /> \ COG Received Emissivity:e) / Container: Thermometer I <br /> EVYES 0 NO Temperature: (A) Q¢ ( °C l (C C Analyst bill j <br /> i , <br /> SAMPLE NUMBERS <br /> SAMPLE CONTAINERS <br /> 2 3 4 5 s 7 8 9 10 <br /> f � <br /> T PE UNPRES <br /> 4oz/Soz I16oz PE UNPRES <br /> 2.Cr" i <br /> T INORGANIC CHEMICAL METALS <br /> INORGANIC CHEMICAL METALS 4oz/Soz/16oz i + <br /> t <br /> PT CYANIDE I <br /> PT NITROGEN FORMS <br /> i <br /> PT TOTAL SULFIDE <br /> 2oz.NITRATE/NITRITE <br /> IT TOTAL ORGANIC CARBON <br /> I <br /> IT CHEMICAL OXYGEN DEMAND <br /> f <br /> PIA PHENOLICS <br /> 40mI VOA VIAL TRAVEL BLANK <br /> 40ml VOA VIAL / ! ! f <br /> T EPA 1664 - I I <br /> PT ODOR <br /> i <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL t <br /> 40 not VOA VIAL-504 i <br /> T EPA 508/6088080 t <br /> T EPA 515.1/8150 <br /> T EPA 525 <br /> i <br /> T EPA S25 TRAVEL BLANK <br /> 40m1 EPA S47 <br /> 40m1 EPA 531.1 <br /> Soz EPA 548 <br /> T EPA 549 <br /> E <br /> T EPA SO15M <br /> T EPA 8270 i 4 <br /> Soz/16oz/32oz AMBER <br /> Saz/1(wz/32oz JAR <br /> i <br /> SOIL SLEEVE <br /> PCB VIAL <br /> PLASTIC BAG i 1 <br /> TEDLAR BAG <br /> FERROUS IRON <br /> i <br /> ENCORE <br /> SMART KIT <br /> SUMMA CANISTER <br /> Comments: <br /> Sample Numbering Completed By: Date/Time• ✓ apv z1 ost23t2o1s <br /> n .. n_.....� r r _ r..-_.......a iS:1WPU¢c\W¢idP¢'I¢cpWa ppeSIFOPMS\SpMSEQev MI j <br /> The results in this report apply to the samples analyzed in accordance with the chain ofcusiody 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 /> Report ID: 1000511734 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.bclabs.com Page 4 of 47 <br />