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Laboratories, Inc. <br />Environmental Testing Laboratory Since 1949 <br />Chain of Custody and Cooler Receipt Form for 1117340 Page 2 of 2 <br />SAMPLE RECEIPT FORM Rev. No. 12 06124/08 Pae - (Qf <br />Comments: <br />Sample Numbering Completed By: Date/Time: <br />A - Actual I C = Corrected SIR-loomitip 11.48 �csvoRwslsnNREcz wro] <br />BC LABORATORIES INC. <br />Submission #: ( '' (H <br />SHIPPING INFORMATION SHIPPING CONTAINER <br />Ice Chest q/ None ❑ <br />Federal Express ❑ UPS ❑ Hand Delivery ❑ Box ❑ Other ❑ (Specify) <br />BC Lab Field Service � Oder ❑ (Specify) <br />Refrigerant: Ice of Blue ice ❑ None ❑ Other ❑ Comments: <br />Custody Seals Ice Chest ❑ ❑NoneComments: <br />ItactT YNo intact?[Cortiainnerss <br />Yes o <br />All samples received? Y o ❑ All samples containers intact? No ❑ Description(s)match CDC? Y O ❑ <br />C®C Received Emissivity: O�. � Container: � Thermometer ID: 1-i'1 Dateltime 1Q <br />YES 0 NO Temperature: A a -� °C / C � • ci °C Analyst Ini4 ,iAr,i <br />SAMPLE <br />SAMPLE CONTAINERS � 2 i 4 s a OT OT 7 e a to <br />QT GENERAL MINERAU GENERAL PHYSICAL <br />PT PE UIVPRESERVED <br />IN RGANIC CHEMICAL METALS <br />Pf INORGANIC CHEMICAL METALS <br />PT CYANIDE <br />PT NTfROG FORMS <br />PT TOTAL FIDE <br />2oL NITRATE / NITRITE <br />PT TOTAL ORG C CARBON . <br />PT TOX <br />PT HEMI .AL OXYGEN DEMAND <br />PtA PHENOLICS <br />40.1 VOA VIAI.TRAVEL LANK <br />1 1 1 1 t I) l 1 1 1 < 1 t t t <br />40m1 YOA VIAL <br />E,413*'ICLI�3 41&1 <br />OG <br />BACTERIOL ICAL <br />40 ml VOA VG1L-504 <br />T EPA 508/6088080 <br />T EPA 515.18150 <br />T EPA 524 <br />T EPA 525 TRAVEL BLANK <br />IOOmI EPA 547 <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 <br />100mi EPA 531.1 <br />EPA 548 <br />T EPA 549 <br />EPA 632 <br />T EPA 8015M <br />T AMBER <br />6 OZ. JAR <br />32 OZ JAR <br />SOIL SLEEVE <br />PCB VIAL <br />PLASTIC BAG <br />FERROUS ON <br />ENCORE <br />Bakersfield, CA 93308 (661) 327-4911 FAX (661) 327-1818 www.bclabs.com Page 4 of 14 <br />