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i <br /> SEQUOIA ANAL'Y'1'IiC.AL S-ANIFLE RECEIPT LOG <br /> CLIEN1 NAAiLF+ ,�. .. ,DATE Received at Lob. 0)1 inking mater)for , <br /> REG BY(PRINT) TIME Received at Lab: regulatory pue pose.; Y FS@ <br /> WORKQRDTR: r p t I.00 LN1)AL%- 1W.1 t1lin (Waste%ater)for <br /> i regulatory purposes <br /> 6�W <br /> CIRCLETIM?A11MOPRIA'I L HYbPONSu LAIC SAMPLE DATE} <br /> s <br /> - SAMPLE fI N CLEW ID DESCMIPfION <br /> MAIRIX SI1iYlPLISU COMMON OW.) <br /> 1 CustodySc$I(t] Prescnl AbsCl <br /> } Cp <br /> Inca t 1 Bra o <br /> 2 Cham of-c"tody rase !Absent* 03 -ct <br /> i 3 Traffic Reports or r-11 <br /> Packing list: Present/ Rent `y l <br /> 4 Ai rlbli Alrbdl f Sticker ' <br /> ITfes At <br /> S AirbrilA <br /> ti. Sang it Labels t/Abaent W , <br /> 7. S"tviple 113s }st !Not Listed <br /> - j on in-ofCustod <br /> S.Sample CoMmon Braker* <br /> Leakm • i <br /> ' 9 Docs mfonnation oa <br /> Custody reports.traffic <br /> reports and sampic <br /> labols rte? ny f NW <br /> 10 Sample received within <br /> hold time+ es o* <br /> i <br /> 11 finger Preaertialives <br /> used. Nei <br /> 112 Temp Ree.at Lab, <br /> =Acceptance,range for aampIcs <br /> ljr5turing lbumal res_1+f 2 Yes/No* <br /> MM MOM <br /> YK i 1t9W ��[SR _ dYa0VA4 YfaYH000"AR <br /> *If Circled, carttactProject Afanagcr and affach record of 1-wohltion. <br /> Sample Recelpt Log <br /> RevWlan 2.1(11 1101M <br /> Replaces Revmiou 2{11106=1 Page of <br /> Effectim 11RMO 7 <br />