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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> (,L1il<.IV I NAME. <br /> DATE Received at Lab. (Drinking water)for <br /> REC BY (PROT) TIME Received at Lab,. regulatory purposes YESINO <br /> WORKORDER LOG IN DATE. lfp� (Wastewater)for <br /> regulatory purposes: YESINO <br /> CIRCLE 1 HE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC) <br /> 1 Custudy Seal(s) Presen sent tl' <br /> In act/Broken* <br /> 2 Cleaw-of-Custod rese /Absent* <br /> 3 Tialfrc Reports or <br /> P,ELktu g List Present/ <br /> 4 Anbill -91/ r <br /> t/Absent <br /> 5 AubillIJ <br /> G Sample Libels &JIt 1 Absent <br /> 7 Sarupk,IDS xst /Not Listed <br /> oxr ha►n-of-Custod <br /> 8 Sample Couditiun 4x /Broken*/ <br /> Leaking* <br /> r <br /> 4 Du"310ormxation on <br /> Lustody repoils,traffic <br /> reports acid sample <br /> labels a eel /No* <br /> lU Samrple r"oi%ed witlua <br /> bold trtue /No* <br /> r <br /> I l hopc►Pxeseivatcves ' <br /> usLd e /No* <br /> 12 1 emp Ret. at Lab <br /> IALceptdnCe iaage for samples <br /> EL iu mrg thetmial PiLs 4+1-2°C) Yes/ o <br /> ~*If Circled, contact Project Manager and attach record of resolution. <br /> Sample ReceApt Log <br /> Reviskm 21 (1 till o/oa) Pae of <br /> keulaces Revis�n20 ttUur'aoi 9 <br />