Laserfiche WebLink
SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME - _ DATE Received at Lau (Drinking water)fur <br /> REC BY(PRINT) TIME Received at Lab �� regulatory purposes Y>i` <br /> y WORKORDER L LOGIN DATE 3 (Wastewater)for <br /> regulatory purposes Y" <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID, DESCRIPTION MATRIX SAMPLED CONDITION(ETC) <br /> 1 1 Custody Seal(s) Presen /Absent <br /> Intact/Bro en* —� <br /> ( 2 Chain-of-Custody re /Absent* <br /> 3 Traffic Reports or <br /> Packing List Present <br /> 4 Airbill Aubill r <br /> Present/ <br /> # 5 Airbill# <br /> 6 Sample Labels resen /Absent <br /> 7 Sample IDs /Not Listed <br /> l on Chaw-of-Custody <br /> S Sample Conditionrtac Broken*/ <br /> ui <br /> r 9 Does wformation on <br /> 1 custody reports, traffic <br /> reports and sample <br /> labels agree? a No* <br /> 10 Sample received withm <br /> hold tune es No* i <br /> 1 I Proper Preservatives <br /> used /No* <br /> 12 Tenip Rec at Lab <br /> (Acceptance range for samples <br /> re uirmthermal pres 4+/-2'C), Yes/No* <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revision 2 1 (11110/00) <br /> Replaces Revision 2(11106/00) page of <br /> Effective 11/12/00 <br />