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! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: i �r _ DATE Received at Lab: 12 / Z `' (Drinking water)for <br /> REC.BY (PRINT) (" flt TIME Received at Lab: u zr'7 regulatory purposes: YESINO <br /> WOI2KORDER: LOG IN DATE: /� "Z''� (Wastewater)for <br /> regulatory purposes: YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB Dash CONTAINER SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION pI3 MATRIX SAMPLED CONDITION (ETC.) <br /> k-1�, 12le <br /> L Custody Seal(s) Present/ se t <br /> Int t/Broken* <br /> $ 2, Cliain-of-Custodyre t/Absent* <br /> t <br /> 3. AirbilL Airbill/Sticker <br /> Present 161 it <br /> 5. Sample Labels: re nt/Absent <br /> 6. Sample IDs: i d I Not Listed <br /> A <br /> o hain-of-Custod <br /> 7. Sample Condition: /broken*/ <br /> Leaking-' <br /> 8. Does information on custody reports, <br /> traffic reports, and sample ' <br /> f <br /> labels agree'? est/No* s <br /> 9. Sample received within <br /> hold time: /No* <br /> X <br /> 10. Proper Preservatives <br /> used: es No* <br /> 0 i <br /> 11. Temperature Blank Received'? Yes/ 3, <br /> 12. Temp Rec. at Lab: vegr�sc <br /> (Acceptance range for samples <br /> re uirin thermal res.:44-2°C) ,/No* <br /> Pi. Samples collected more <br /> than 4 days ago? Yes ' N <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revision 2.2(8130104) Page_of - <br /> Replaces Revision 2.1 (11110/00) FIGURE 6b <br /> r fnnfive Q11/04 <br />