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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG. �l <br /> }o k, For Regulatory Purposes? <br /> f <br /> CLIENTNAME, �}t:�tl 4�rocJ� t?�n - - - -. DATE REG'D AT LAB: t C 9 ry p <br /> 21 <br /> REG.BY(PRINT) TIME RECD AT LAB: DRINKING WATER YES;) <br /> WORKORDER; M P wo �Z — BATE LOGGED 1N: T I1S � WASTE WATER YES <br /> N(l4u�t�vclv�ti 4 <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV SAMPLE ' DATE REIdARKS: <br /> SAiViPLE# # CLIENT ID DESCRIPTION ATIVE PR MATRIX SAMPLED CONDITION(ETC.) <br /> 1. Custody Seal(s) Present/1sent 1 uhi w,okk <br /> jWacl/Broken* It`l :Sca <br /> 2. Chain-of-Custody ese /Absent* S90 , <br /> 3. Traffic Reports or• k <br /> Packing List; Present/ sent, <br /> 4. Airbill: AirbNll/Sticker Wow, <br /> Present/ bsent — <br /> 5. Airbill#: <br /> B. <br /> Sample Labels: rase /Absent <br /> 7. Sample lDs: iste�j Not.Listed <br /> on pain-of-Custod <br /> 8. Sample Condition: QntacjI Broken*/ <br /> L®akin * <br /> 9. Does information on chain-of-custody, <br /> traffic reports and sample labels <br /> agree? e /No* <br /> y <br /> 10. Sample received within <br /> hold time? Y '1 No* <br /> 11. Adequate sample volume <br /> received? Y /No* <br /> 12. Proper preservatives used? !No <br /> 13.Trip Blank f Temp Blank Received? I r <br /> circle which,If yes) Ye 6 G <br /> ,14. Read Temp: `. <br /> Corrected Temp: fi ° <br /> is corrected temp 4+/-20C? `Yes_J No** 1 <br /> *(Acceptance range for samples requiring thermal res. <br /> r"Exception(if any): METALS / DFF N lC - <br /> i'' or Problem COC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION. f <br /> 1�R[.revision 7 <br /> `laces Rev 5(07113104) Page_ni <br /> R; <br />