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Laboratories <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1214098 Page 2 of 2 <br /> BC LABORATORIES INC. COOLER RECEIPT FORM Be..No.12 12/30110 Page-L Of <br /> Submission# --t U 19 <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express ❑ J1PS❑ Hand Delivery ❑ Ice Chest W None ❑ <br /> BC Lab Feld Service frfi/ Other❑(Specify) Box ❑ Other ❑(Specify) <br /> Refrigerant: lcejffZ Blue Ice❑ None ❑ Other❑ Comments: <br /> Custody Seals Ice ig w�h No ni l"inct!Vp. n No J, <br /> Cliesf q Coilfainers.13 None Comments: <br /> :;� .. . <br /> All samples received? Yes 0 No O All samples containers intact? Yes❑ No❑ Descriptlonlsl match COC? Yes❑ No ❑ <br /> COC Received Ernissivity: D,61P Container: Thermometer ID: f11 Daterrtme1-11 1n. <br /> YES ❑ NO <br /> Temperature: (A) I C I Analyst Inft JCA `� <br /> 'SAMPLE NUMBERS <br /> SAMPLE CONTAINERS <br /> 1 ] 3-7-4 5 6 7 B e 70 <br /> OT GENERAL MINERAL/GENERAL PHYSICAL �Z't ') •7 ') <br /> PT PEUNPRESERVED <br /> T INORGANIC AL METALS <br /> 1'r INORGANIC CHEMICAL METALS C- <br /> PT <br /> PT CYANIDE p'•�, <br /> Pr NITROGEN FORMS I <br /> PT TOTAL SULFIDE <br /> 2M NITRATE/NITRITE <br /> PT TOTAL ORGANIC CARBON <br /> PT TOX <br /> PT CHMICAL OXYGEN DEMAND <br /> PtA PIlENOLICS <br /> 40mlVDA VIAL TRAVEL BLANK <br /> 48m1 VOA VIAL <br /> Sff EPA 4212.413.7-41&1 <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 nd VDA VIAL'SIN <br /> EPA 508!001118080 <br /> EPA 515.1/8150 <br /> -QT EPA P5 <br /> . TEPA-57S'TRAVELBLkNK-----'-- --..---- — - - -- -- <br /> 100m1 EPA 547 <br /> 100ml EPA 53LI <br /> T EPA 548 <br /> EPA 549 <br /> T EPA Gil <br /> T EPA 8015Tt <br /> OT MMER <br /> 8 OZ JAR <br /> 32 OZ JAR <br /> SOIL SLEEVE <br /> PCB VIAL <br /> PLASTIC BAG <br /> FGRROUSIRON <br /> ENCORE <br /> Comments-. <br /> Sample Numbering Completed By: 1 DateiTime: <br /> A e Actual t C.a.Cauecied <br /> �i,'�J tc:tM.nocsiwwrme,tccrttas oocsv-onansis>mrkc2l <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.bdabs.com Page 4 of 40 <br />