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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> DATE Received at Lab (Drinking water)for <br /> f �2 1 <br /> CLIENT NAME: — regulatory purposes: YES/NO <br /> _ TIME Received at Lab: C�= <br /> REC.BY (PRIN't') ° � LOG IN DATE: '2= r _ (wastewater)for <br /> WORKORDER: !'�'� � / YES/NO <br /> regulatory purposes: <br /> CIRCLE THE APPROPRIATE RESPONSE LAB Dash <br /> CONTAINER SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION pI3 NIATI2IX SlyLEll COI, <br /> (ETC) <br /> Z. <br /> L Custody Seal(s) Present/ bse5t <br /> Int t/Broken* <br /> 2. Chain-of-Custod rc fit/Absent* ! <br /> 3. Airbill: Airbill/Sticker <br /> Present/. apt <br /> 4. Airbill - <br /> `. 5. Sain le Labets: ;Pre m/Absent <br /> 6. Sample IDs: it'd/Not Listed <br /> oti Chain-of-Custod <br /> 7, Sample Condition: tact(` roken*/ <br /> Leakin * _ <br /> 8. Does information on custody reports, <br /> traffic reports,and sample <br /> labels a ree? e•/No* <br /> - <br /> 9. Sample received within <br /> !. hold time: �s/No* .._ — <br /> 10. Proper Prese.cvatives <br /> used: esNo* O <br /> l 1. 'rem cralure Blank Received'? Yes% o / z- V <br /> j 12. Temp Rec.at Lab: <br /> (Acceptance range for samples <br /> equiring hernial tes.A-i/-2'C) �l e/No* <br /> 13. Samples collected more /<1 — <br /> tban 4 days a o? Yes " N <br /> G.. . , .,x ,.... <br /> elI Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log Page_of— <br /> Revision 2.2(6130/04) - <br /> Replaces Revision 2.1 111!10100) FIGURE 6b <br /> rifamwv W 1414 <br />