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SEQUOIA ANALYTICAL SAMPLE RECENT LOG <br />' CLIENT NAME <br /> B DATE Received at Lab 2 (Prinking water)for <br /> REC BY (PRINT) TIME Received at Lab j 4- <br /> ER <br /> regulatory l�url�oses YES/NO <br /> l�VOItKO[It)ER LOG IN DATE '� (Wastewater) for <br /> regulatory purimses YES/NO <br /> II <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE#T# CLIENT ID DESCRIPTION MATRIX SAMPLED <br /> CONDITION(ETC) <br /> 1 Custody Se'tl(s) Present scn — 3X l0 1 <br /> Intact/Broken" <br /> 2 Chain-of-Cuslod Rues t Absent* 10 <br /> 3 Traffic Repot Is or 11. <br /> Packing List Present 1 Abse <br /> 4 AnbilL Airbill/Sucker ��ii,`�� <br /> Present se UC`T I�J'— {O <br /> t 03 <br /> 5 Anbilt# I <br /> G S-imple Labels r /Absent <br /> 7 Smnple IDsLtste Not Listed Q rTB <br /> on Chain-of-Custnd <br /> 8 Sample Condition Iieta Broken"/ <br /> Leaking* <br /> 9 Does information oil <br /> custody repoi Is, traffic <br /> eeports acid sample <br /> labels a gice? e /No* <br /> lt) Sample received within <br /> Bold lime Ye No* <br /> 11 Proper Preserwitives <br /> used <br /> 12 Temp Rec at Lab <br /> (Acceptance range for samples <br /> sic uilin g thermal res 4H-2'Q e rto* <br /> If Citc(ed, cotrtact P,o,ect Manager and attach record of resolution <br /> I <br /> bample Receipt Log <br /> Recision 2 1 (1Ill 0100) Page of <br /> Replaces Revision 2(1 11015 0) <br />