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• • • <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG - <br /> CLIENT NAME. (.(ZS DATE Received at Lab. `'-C4 (Drinking water)for <br /> IEC. BY (PRINT) TIME Received at Lab: 1 regulatory purposes: YES/NO <br /> WOItICORDER LOG IN DATE. (Wastewater)for <br /> pc� regulatory purposes: YESMO <br /> CIRCLE TIIE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC-) <br /> 1 Custody Seal(s) Present I sen tia <br /> Intact/Broken' I 1 A <br /> 2 Cltratn-of-Cuslod 1' eSt I Absenl* v <br /> 3 Tr.ffic Repatts or s` <br /> PdLkhig LISt Present/x0t <br /> 4 Aubill Arrball/Sticker <br /> Present/A se t <br /> S AllbL11# <br /> G Sam lc.Labels t/Absent <br /> 7 Saauptc IDs (!!�ed/Not Lasted <br /> on Chain-of-Custod <br /> 8 Sa1,11plc Condition nt t/Broken*1 <br /> Leakua * <br /> 9 Dues rrrfurrrraUou on <br /> custody reports, traffic <br /> reports and wnple <br /> labels a ice t e !No* <br /> to Sample aecetved witlun <br /> liold URIC 1 No* <br /> Ii Proper Preservatives <br /> used e !No* <br /> 12 Tc1up Ru. at Lab <br /> (NC(,eptartcc s ange for samples <br /> rc uIcln (h:rival pres 4+/-2°C) s No- x <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revisinn21 (11110100) <br /> Replaces Revision 2(111066) Page Of <br />