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m <br /> aceAna/ytica/ <br /> ENVIRONMENTAL SCIENCES <br /> Chain of Custody and Cooler Receipt Form for 2601733 Page 3 of 4 <br /> PACE ANALYTICAL COOLER RECEIPT FORM <br /> Submission#:'Z Page Of <br /> SHIPPING INFORMATION <br /> Fed Ex ❑ UPS❑ GSO/GLS❑ Hand Delivery ❑ Ice CSHIPhest�NG CONTAINER ❑ FREE (QUID <br /> Pace Lab Field Service t� Other❑(Specify) YE NO ❑ <br /> Other ❑(Specify) <br /> W /.S <br /> Refrigerant: Ice Blue Ice❑ None❑ Other❑ Comments: <br /> Custody Seals Ice Chest❑ Containers❑ None N Comments: <br /> Intact?Yes❑ No❑ Intact?Yes b No❑ <br /> All samples received? Yes a No❑ All samples containers intact? Yes MI No❑ <br /> Description(s)match COG? Yes No O <br /> COC Received Emissivity: d' Thermometer to: 3 b 7 Datelrlme <br /> (( ty q� container: <br /> 2/3/Z6 2/50 <br /> `Et]YES ❑NO <br /> Temperature: (A) O } eC / (C ) oC ) <br /> Analyst Init CL Z <br /> SAMPLE CONTAINERS SAMPLE NUMBERS <br /> I <br /> T PE UNPRE$ .I }•i 3 4 6 6 7 8 9 10 <br /> 4oz/8oz11 PE UNPRES 7 •1 <br /> 2oz Cr4 Z <br /> T INORGANIC CHEMICAL METALS <br /> INORGANIC CHEMICAL METALS 4oz/8oz/l6oz <br /> PT CYANIDE <br /> PT NITROGEN FORMS <br /> PT TOTAL SULFIDE <br /> ITRATE/NITRITE -- <br /> PT TOTAL ORGANIC CARBON <br /> PT CHEMICAL OXYGEN DEMAND <br /> PIA PHENOLICS <br /> 40.1 VOA VIAL TRAVEL BLANK <br /> 40.1 VOA VIAL -` ,` <br /> PT ODOR <br /> RADIOLOGICAL <br /> BACTERIOLOGICAL I <br /> 40 ml VOA VIAL.504 <br /> T EPA 508/608.3/8081A <br /> QT EPA 515-118151A -- <br /> T EPA 525.2 <br /> T EPA 525.2 TRAVEL BLANK <br /> 40m1 EPA 547 - <br /> 40m1 EPA 531.1 - <br /> Saz EPA 548.1 <br /> T EPA 549.2 — <br /> T EPA 8015M <br /> T EPA 8270C. <br /> Saz I16oz/32oz AMBER <br /> 8oz/16oz 132oz JAR - <br /> SOILSLEEVE - <br /> PCB VIAL <br /> PLASTIC BAG - - <br /> TEDLAR BAG <br /> FERROUSIRON <br /> ENCORE <br /> SMART KIT - <br /> SUMMA CANISTER <br /> Comments: <br /> Sample Numbering Completed By: Date/Time: Z._mot 7V <br /> A=Actual 1 C=Corrected Rev 13 06120;12 <br /> 15:lWPOalWord drr IAB DOCSI ORMSISMRECm,101 <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. Pace Analytical assumes no responsibility for report alteration,separation,detachment or third party interpretation. <br /> Report ID: 1001665842 4100 Atlas Court Bakersfield, CA 93308 (661)327-4911 FAX(661)327-1918 www.pacelabs.com Page 6 of 109 <br />