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i ! 0 <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> 4 CLIENT NAME' DATE Received at Lab. Z/--� _- (Dunking water)for <br /> REC BY (PRINI) TIME Received at Lab: regulatory purposes. YESINO <br /> WORKORDER LOG IN DATE' (Wastewater)for <br /> regulatory purposes- YFSINO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC) <br /> 1 Custody Seal(s) ret <br /> i <br /> — at/Broken* <br /> 2 Cliain-cf-Custodyrese t/Absent* S' s <br /> 3 Traffic Reports or <br /> Packing List Present Qt <br /> 4 Airbill � 111 Sticker <br /> res nt l Absent <br /> 5 Airbill# <br /> 6 Sample Labels re nt./Absent ?- <br /> 7 Sample 1Ds rs /Not Listed <br /> orrChain-of-Custod <br /> 8 Sample ConditionJri ct 1 Broken*! Q <br /> Leaktn * <br /> 9 Does information on t' <br /> custody reports,traffic <br /> reports and sample <br /> labels a reele /No* <br /> a <br /> 10 Sample received within <br /> hold tune 1 No* <br /> ll Proper Preservatives <br /> used 1 No* <br /> 12 Temp Rec at Lab <br /> (Acceptance range for samples <br /> requiring thermal pres 4{I-2°C) s 1 No* <br /> ._r.i,i. T,ilx<vx qua xe.. +a`k +A^s.vT.t` F x(u a+eM .` .Y YRr a'iFehw i .. • '^ <br /> *If Circled, contact Protect Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revision 21 (11110/00) Pae of <br /> Replaces Revision 2(11/06/00) <br /> Effective 11/12100 <br />