Laserfiche WebLink
SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG S <br /> CLIENT NAME: DATE RECD AT LAB: S t td 1, For Regulatory Purposes? <br /> REC.BY(PRINT) TIME REC'D AT LAB: DRINKING WATER YES NO <br /> WORKORDER; /l P [�. S�)' DATE LOGGED IN; �I1s y WASTE WATER YE - N(7 <br /> r CIRCLE'THE APPROPRIATE'RESPONSE <br /> LAB BASH CONTAINER PRESERV H JSAIVIPLEJ' DATE" REMAFIKS: <br /> SAMPLE# # CLIENT ID DESCRIPTION ATIVE P MATRIX SAMPLED CONDITION(ETC.) <br /> 1. Custody Seal(s) Present/7sent C 1;[:P.I� 1 b <br /> _lAardI Broken* <br /> 2. Chain-of-Custody ese- I Absent* <br /> 3.Traffic Reports or- 1 " <br /> Packing List: Present/ <br /> 4. Alrbill: Airbill/Sticker V0a_X <br /> Present/ bsent - <br /> 5. Airbill#: <br /> 6. Sample Labels: (,P-resent'/Absent <br /> 7. Sample IDs: isted Not.Listed <br /> on pain-of-Custod <br /> [8:Sample Condition: ntac Broken*lLeakin *. Does information an chain-of-custody, <br /> traffic reports anj sample label <br /> agree? e 1 No* <br /> _10. Sample received within <br /> hall lime? Y ' 1 No* <br /> 11. Adequate sample volume <br /> received? Y /No* <br /> 12. Proper preservatives used? Y No* <br /> 13.Trip Blank!Tom Blank Received? i <br /> circle which,If yes) Ye m <br /> 614. Read Temp: ab <br /> ,� <br /> Corrected Temp: -C ' C <br /> Is corrected temp 4 4-271,7 Yes,/No <br /> (Acceptance range for samples raqulring thermal res. 1 <br /> "Exception If an METALS ! DFF N lC - LE <br /> ` or Problem COCis <br /> - <br /> '� *IF CIRCLED,CONTACT PROJECT MANAGER-AND ATTACH RECORD OF RE=SOLUTION. <br /> W+'9RL Revislon 7 Page_of _ • <br /> 'aces Rev 5(07113/04) <br /> `N07119105 i; <br />