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I I r 1 1 I t r r r I r r r r r r r r <br /> SEQUOIA ANALY'T'ICAL SAMPLE Rr.CI:TPT LOG <br /> CLUNT NAhIE; R / DATE Received at ratb: NI' t) (Drinking tvaler)for <br /> REC.BY(PRINT) �r��{ (4 TIMR Received al Lab: �q{ D regalatury purposes: Y6S\J <br /> � <br /> WORKORD.R: LOC.IN DATE: — (Ilraatewaler)for <br /> rcgnfatory parpOsea; YF <br /> CIRCLE TIIE APPROPRIATE RESPONSE LAB SAA1Pl.ft I)A'J')+ <br /> SAINIPJJt# # CLIENT Ill ))I+.SCRIPTrON UATRIX SAafPLED CONDJTION(PrrC.) <br /> 1.Custody Seal(s) Present/ bs <br /> Intact/Broken* <br /> 2.Chain-of-Cuslod resent Absent- L 175 - <br /> 3.'Craffic Reports or L—a—& <br /> Packet List: Prescat/`Absont' 5 <br /> 4.Airbill: A)rbill I Sticker <br /> Present <br /> S. Airbill t!: <br /> i fi. Sarn lr.Labels: Prescn[lAbsent <br /> 7, Sample IDs: lAlot Listed <br /> Oil Catlin-of-Custody <br /> 9. Sample Condition: (fn?atq Broken*1 <br /> nl <br /> 9. Does Monnaliou on <br /> custody reports,traffic <br /> repurts and sample <br /> labels agree? 1 No* <br /> 10. Sample rcecived wilhiin <br /> huldtimc: /No' <br /> 11. Proper Preservatives I <br /> rued: <br /> 12. Temp Rco.at Lab: <br /> (Acceptance range for samples <br /> requiring thermal res.:441-2°C) Yes No* <br /> nan x rovzcw�mrw.un r a..o-ec <br /> 'Ircircled, contact Project Manager and altach record of resallltion. <br /> Sample Reeetpt Lag <br /> Revlsicn1i(11/10100) <br /> Replaces Wslon 2(11!06100) Paye of <br />