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4 <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAi1 P ^ CATF RECD A 1 LAB.�T t� '0 DRINKING WAT li for <br /> REG BY(PRINT) ,— � -TIME RE C'D AT LIB q(Lir retglrlat4r <br /> y purposes' YES! <br /> WORKORDER JnU —SZ DATE LOGGED IN j`E {' WASTE WATER for <br /> regulatory purposes YES D <br /> -T CIRCLE THE APPROPRIATE RESPONSE I.A -� "' Ct IF-NT ID - -C(]hkTAIHER'^PE CSERV SAMPLE DATE` L REMARKS. <br /> 9AMPI F-# # DESCRPTION ATiVE MATRIX SAMPLED CONDITION(r-TC) <br /> I2 <br /> l (:trSlDdj+Seal(s) Present s _ &Ck _ T C , <br /> 2 Cb-am aE Custod Ptese Absent, <br /> I R �� - <br /> 3.Traffic Replts or <br /> Packn I Ist Present <br /> 4 Airl?ill Slicker — �„ <br /> 6 '7 .. <br /> - s !Absen_( a <br /> A1rbiIl# _I 0 o l o o 7,27 Vo$ - <br /> 5 Sample Label- _ rasent Absent <br /> 7 Sample IDs J .l Dial Listed <br /> a Sample Con anin Intaet Broken' / _ — - <br /> Leafun9,--goes information on y✓ _ i; <br /> chain-of-custody, lraNlc .. , <br /> roports and sample -- <br /> _labels agree? <br /> il] Sample received within' - <br /> hold lime' !No' tpl• q _ <br /> I i- Adequate sample volume - <br /> received? _ e J No'w.� <br /> 12 Proper Presorvatives <br /> used _ �1 too* ------ <br /> 13 Temp Rec.at I-ab- <br /> Is temp <br /> b-Istemp 4 Yl-2"C7 Y s7hio92 _ <br /> (Aamplance(arigo fur sgmples rejuiring thermal pies) _ . — <br /> F;xceptlon(If any) METALS f D>=F QN ICE <br /> r�`l'I i'r4hieln GQG_ - <br /> .1L ry 4xls '1 LED, CONTACT PROJ1wCT MANAGER AND ATTACH RECORD OF RI✓ OLt3TIQN <br /> 4(Jill 0103) <br /> S Revision 3(03118!03) ,_ Page <br />