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m <br /> aceAna/ytica/ <br /> ENVIRONMENTAL SCIENCES <br /> Chain of Custody and Cooler Receipt Form for 2601495 Page 4 of 4 <br /> PACE ANALYTICAL COOLER RECEIPT FORM Page Of <br /> Submission#: <br /> SHIPPING INFORMATION SHIPPING CONTAINER FREE;ylCtUit7 <br /> Fed Ex ❑ UPS❑ GSO/GLS O Hand Delivery ❑ Ice Chest'd None ❑ Box ❑ YE' 17 NO ❑ <br /> Pace Lab Field Service Other❑(Specify) Other ❑,(Specify) — --W <br /> Refrigerant: Ice Blue Ice❑ None❑ Other❑ Comments: <br /> Custody Seals Ice Chest❑ Containers❑ None Comments: <br /> Intact?Yes❑ No❑ Intact?Yes O No❑ " <br /> .All,samples received? Yes No❑ All samples containers intact? Yes No❑ Description(s)match CCIC? Yes No ❑ <br /> COC Received Emissivity: 6'D Container: Thermometer ID: 21 Daterrime LZ Z� 1 y5 <br /> YES ❑NO Temperature: (A) 'C / {C ) ? °C Analyst Init C 1 2 <br /> SAMPLE NUMBERS <br /> SAMPLE CONTAINERS 1 2 3 q 5 s 7 <br /> OT PE UNPRES <br /> 4ozl8oz! PEUNPRES '� <br /> 2oz Cr'' <br /> T INORGANIC CHEMICAL METALS <br /> INORGANIC.CHEMICAL METALS 4oz/Soz/16ez <br /> PTCYANIDE —� <br /> PT NITROGEN FORMS <br /> Pr TOTALSULFIDE. — <br /> 2oz.NITRATE/NITRITE <br /> I'T TOTAL ORGANIC CARBON <br /> PT CHEMICAL OXYGEN DEMAND <br /> 16A PHENOLICS .- <br /> 40n,1 VOA VIAL TRAVEL BLANK <br /> 40:nI VOA VIAL -L -G. -C- A,G -6- <br /> -G <br /> C T EPA I664B <br /> PTODOR <br /> 1•Amol.ocicAL _ � <br /> BACTERIOLOGICAL —' <br /> ao nd voA vlAh. - -� CAC -C <br /> T EPA 508/608.3I8081A — -- I <br /> QT EI'A 515.1l815L1 � -. .i <br /> II T EPA 52S.2 —--� <br /> J 01'FPA525.2TRAVEL BLANK <br /> it <br /> 40m1 EPA 547 .-- --- <br /> 40nil EPA 5XI — <br /> 8-F,.PA 548.11 f <br /> OT F,?A 549.2 __ _ _ — --• ---Il- <br /> T EPA 801.Sh1 <br /> QT EPA 8270C -- _-- --- i <br /> 1 8nz/16oz/32oz nhIBBR_ - — - -- ---f--` �I <br /> Bnz/l6cz/32or.JAR <br /> SOILSLEEVE <br /> PCB V'IAI. -� _-- -- ---- <br /> PLASTIC BAG _ -- -- --•-- <br /> 'rE1lLAR BAG _ — — -- -• — <br /> FFRROUSIRON -- —•- ---I <br /> ENCORE --j <br /> SMART KIT <br /> Comrlients: <br /> Sample Numbering Completed By: 3�_ Date/Time:_���� RevT3 35/zC,?2 <br /> A=Actual ! C=Corrected I5:IRTDv°IKbrdP.,fW1LAB OOCS'TORM515AMR9-201 <br /> The results in this report apply to the samples analyzed in accordance with the chain of c stody 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: 1001665557 4100 Atlas Court Bakersfield, CA 93308 (661)327-4911 FAX(661)327-1918 www.pacelabs.com Page 8 of 118 <br />