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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME DATE Received at Lab 5 U`t (Drinking i►ater)for � <br /> REC. BY(PRINT) ATJ TIME Received at Lab, regulatory purposes I E5/NO <br /> WORKORDER 3 Y LOG IN DATE 7 0 (Wastewater) for , <br /> regulator lturl9se4 1 Eq/NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRLY SMtPLED CONDI?ION(E7 C) <br /> 1 Custody Scal(s) Present/ <br /> 1ntqaZBtik0 <br /> 2 Cham-of-Custody t/Absent* <br /> 3 Traffic Rcports or <br /> Packnig List Present/ bsen <br /> 4 Aubill A1rbill/Stickzr— <br /> Present r4sent <br /> 5 Ambill# <br /> G Sam lc Labcls 11Y/Absent <br /> 7 Sample Ills1st /Not Listed <br /> on Chaux-of-Custody <br /> 8 Sample Condition �a /Broken*/ <br /> 9 Does nlformawil on <br /> Lustody reports, traffic <br /> reports and sample <br /> labels agree? 4rf /No* <br /> 10 Sample received wetlun <br /> hold tmtic 4VIs/No* <br /> f <br /> 11 Prober Preservatives <br /> used s/No* <br /> 12 Temp Rec at Lab <br /> (Acceptance raelge for samples <br /> rc m reit�thei a res 4+/-2°C) Yes 1 <br /> *If Cie cled, contact P1 olect Manager and attach record of resolution <br /> Sampl <br /> -(,Pt <br /> Log <br /> i Revtsi (11l1olot7) <br /> Replaces eviston 2(1110G![0) Page of*- <br />