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Laboratories Inc�1949 <br />Environmental Testing Laboratory Since <br />Chain of Custodv and Cooler Receipt Form for 1118171 Paae 2 of 2 <br />3C LABORATORIES INC. SAMPLE RECEIPT FORM Rev. No. 12 06124/08 Pae Of <br />Submission #: <br />SHIPPING INFORMATION$HIPPING <br />Federal Express ❑ UPS ❑ Hand Delivery ❑ <br />BC Lab Field Service [ Other ❑ (Specify) <br />CONTAINER <br />Ice Chest,Pf' None ❑ <br />Box ❑ Other ❑ (Specify) <br />Refrigerant: Ice Blue Ice ❑ None ❑ Other ❑ Comments: <br />Custody Seals Ice Chest ❑ Containers O' None,/Comments: <br />In ?Yes No Intact7`e, No ❑ <br />All samples received?Y No ❑ All samples containers intact? Yes o ❑ Description(s) match COC o 0 <br />COC Received Emissivity: 0�7 Container: � Thermometer ID: �_ Date/Time <br />1 01,10 <br />Pd YES i] NO Temperature: A , °C I C 5 °C Analyst <br />SAMPLE CONTAINERS 1 2 ; 4 s 8 t a e 10 <br />OT GENERAL MINERALJ GENERAL PHYSICAL <br />PT PE UNPRESERVED <br />T INORGANIC CNIICAL METALS <br />PT INORGANIC CHEMICAL METALS <br />PT CYANUDE <br />PT NlTRQG1LN FORMS <br />PT TOTAL SULFIDE <br />2oz NITRATE / NITRITE <br />PT TOTAL ORGANIC ON <br />PT TOX <br />PT cHEMicAL O%YGEN DEMAND <br />PtA PHENOLICS <br />40.1 VOA VIAL TRAVEL BLANK <br />1 l 1 t 1 1 1 ) 1 1 1 ) 1 1 1 <br />40m1 VOA VIAL. <br />T EPA 413.1 4131 418.1 <br />PT ODOR <br />RADIOLOGICAL <br />BACTERIOLOGICAL <br />40 .1 VOA VIAL- 504 <br />OT EPA 508/6088080 <br />T EPA 515.1/8150 <br />T EPA S25 <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 />OT EPA 8015M <br />T AMBER <br />8 OZ. JAR <br />32 OZ. JAR <br />SOD. SLEEVE <br />PCB VIAL <br />PLASTIC BAG <br />it FERROUS IRON <br />ENCORE <br />Comments: <br />Sample Numbering Completed By: DateMme:UZtr% <br />A = Actual I C = Corrected pt:t0oCMWP8e1LAa DOC3IFORAASISAMREC2WPDJ <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) 3274911 FAX (661) 327-1918 www.bclabs.com Page 4 of 18 <br />