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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: 1P DATE Received at Lab; I A2—s-9 (Drinking water)for <br /> > REC.BY (PRINT) TIME Received at Lab: regulatory purposes: YESINO <br /> r <br /> WORKORDER; LOG IN DATE: (Wastewater)for <br /> regulatory purposes: YESflKO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC.) <br /> I Custody Seal(s) nt <br /> nt /Broken" 2 <br /> 2 Chain-of-Custodyres /'Absent* J <br /> 3 Traffic Reports or <br /> Packing List Present/ bsen G/ <br /> 4 Airbill, Airbilll Su <br /> Present 1� bsen <br /> 5 Airbtll# <br /> 6 Sample Labelst/jAbsent <br /> 7 Sample IDs 690— <br /> d 1 Not Listed <br /> on -barn-of-Custod <br /> 8 Sample Condition tac /Broken* <br /> / <br /> Vkin <br /> 9 Does information,on <br /> custody reports,traffic <br /> reports and sample <br /> labels a reeles No* <br /> 10 Sample received wntlun <br /> 3 hold time e !No* <br /> 11 Proper Preservatives 1 <br /> usede 1 No* <br /> 12 Temp Rec at Lab - <br /> LAcceptance range for samples <br /> riil thermal res 4+1-2°C} i e /No*y �. <br /> 71 T"M WMA <br /> *If Circled, contact Pro`ect Manager and attach record of resolution. <br /> Sample Receipt Log <br /> o Revision 21 (1 ill 0/00) page of <br /> Replaces RevisEen 2(11/066) <br />