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I <br /> • 0 <br /> I <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: DATE REC'D AT LAB• -- �—�ti For Regulatory Purposes? <br /> REC BY(PRINT) G TIME REC'D AT LAB. • DRINKING WATER YES <br /> WORKORDER. PG 6 Ct DATE LOGGED IN. - ,- er WASTE WATER YES 2 <br /> ; <br /> r <br /> CIRCLE THE APPROPRIATE RESPONSE LAB [SASH CLIENT IIT CONTAINER PRESERV PH SAMPLE OA CE REMARKS. � <br /> i <br /> SAMPLE# # DESCRIPTION ATIVE MATRIX SAMPLE} CONDITION(ETC <br /> 1 Custody Sea)(s) Pr nt/A <br /> token* <br /> 2 Chain-of-Custody Absent* ' <br /> 3 Traffic Reports or <br /> Packing List- Present 1 sent z <br /> 4 Alrbill. Airbill l Stic <br /> Present 1 A <br /> S Alrbill# ` <br /> s Sample Labels res /Absent <br /> 7 Sample IDs Este#Not Listed <br /> on Chain-of-Custody <br /> 8 Sample Condition act roken*1 <br /> in <br /> 9. Does information on chain-of-custody, <br /> traffic reports and sample label -� <br /> agree? No* <br /> 10. Sample received within <br /> hold tame? No* mAl <br /> 11 Adequate sample volume <br /> received? e <br /> V Proper preservatives used? o' <br /> 13 Trip Blank/Temp Blank Received? <br /> circle which,H s Yes <br /> 6W Z '.. <br /> 14 Read Temp � . <br /> Corrected Temp <br /> Is corrected temp 4+1-2°C? Ys l o** <br /> (Acceptance range for samples regwring thermal pros) <br /> y*"Exception (if any) METALS / DFF ON ICE <br /> i <br /> or Problem COC <br /> ` r "IE CIRCLED,CONTACT PROJE=CT MANAGER AND ATTACH RECORD OF RESOLUTION l nr <br /> .SRL Revision 7 page f /bI <br /> Replaces Aev 6(07113/04) <br />