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Laboratories Inc. � 1 <br /> Environmental Testing Laboratory Since 1949 <br /> Chain of Custody and Cooler Receipt Form for 1201155 Page 2 of 2 <br /> BC LABORATORIES INC_ SAMPLE RECEIPT FORM Rev.No.12 06124/08 Page L Of i <br /> Submission#: I-.-Q it 1S <br /> SHIPPING INFORMATION SHIPPING CONTAINER <br /> Federal Express ❑ UPS❑ Hand Delivery ❑ Ice Chest None ❑ <br /> BC Lab Field Service * Other D(Specify) Box D Other ❑(Specify) <br /> Refrigerant: Ice-V. Blue Ice O None❑ Other❑ Comments: <br /> Custody Seals Ice Chest❑ Containers O None Comments: <br /> Intact?Yes D No D Intact?Yes D No❑ <br /> Ali samples received? Ye!�W No D All samples containers intact? Yes`g No❑ Description(s)match COC? YesV No D <br /> COC Received Emissivity: 00" Container: Qp Thermometer ID: 11-171 DateMme <br /> L�Y_ <br /> ES 0 NO t T <br /> Temperature:A ) { `C i C r7i.5 `C Analyst Init sew �O <br /> SAMPLE CONTAINERS 2 4 s s 7 e s to <br /> OT GENERAL MINERAL/GENERAL PHYSICAL <br /> PT PE UNPRESER VED <br /> T INORGANIC CHEMICAL METALS <br /> PT INORGANIC CHEMICAL METALS G GD G C) D i:. <br /> PT CYANfDE { <br /> PT NITROGEN FORAIS G G E <br /> PT TOTAL SULFIDE <br /> 2oa NITRATE 1 NIMTE <br /> PT TOTAL ORGANIC CARBON <br /> PY TOX <br /> PT CHEMICAL OXYGEN DEMAND <br /> PtA PHENOLICS <br /> 40-1 VOA VIAL TRAVEL BLANK /� <br /> 40.1 VOA VIAL 13 fl 13 1 13) I I I t 1 A 1311 1 1 1 i > <br /> T EPA 413.1,413-2,418.j <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL <br /> 40 m1 VOA VIAL-SD4 <br /> T EPA 509160MOSO <br /> -T EPA 515.118150- <br /> T EPA 525 <br /> T EPA 525 TRAVEL BLANK <br /> 100-I EPA 547 <br /> 100m1 EPA 531.1 <br /> T EPA 548 <br /> T EPA 549 <br /> T EPA 632 <br /> T EPA 8015M <br /> 7 AMBER <br /> B OZ JAR <br /> 32 02 JAR <br /> SOIL RLEEVE <br /> PCB VIAL <br /> PLASTIC DAG <br /> FERROUSIRON <br /> ENCORE <br /> Comments: - <br /> Sample Numbering Completed By: Date/Time: — �"` CCt¢�Cj <br /> A=Actual I C=Cnrrecled M:tDOCS%WP801LA8 DOCStFDRMSMAMREC2.WPDl <br /> The results in this report apply to the samples analyzed in accordance with the chain of custody document.This analytical report must he reproduced in its entirely. <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 49 <br />