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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: v DATE Received at Lab: />�� (Drinking water)for <br /> REC. 13Y(PRINT) J TIME Received at Lab: 1 /0D z7 regulatory purposes. YESINO <br /> WORKORDER: 94b L il�'� LOG IN DATE: � (Wastewater)for <br /> regulatory purposes YESINO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC.) ; <br /> 1 Custody Seal(s) Absent <br /> ,Intact Broken* j <br /> r <br /> 2 Chain-cf-Custodyrese !Absent* <br /> 3 Traffic Reports or <br /> Packing List ri-ese <br /> AkAbsent <br /> 4 Airbill Aiibil tic rer q2 5 E <br /> Presen /Absent ] <br /> x <br /> S Airbill# <br /> 6 Sample Labels kre iselppAbsent <br /> 4 <br /> 7 Sample 1Ds Not Listed <br /> on n-of-Custod <br /> 8 Sample Condition ~to roken*! <br /> li <br /> Leaking* s <br /> 9 Does information on <br /> custody reports,traffic <br /> reports and sample <br /> labels agree? o* <br /> 10 Sample received within <br /> Bold time /No* <br /> 11 Proper Preservatives <br /> used Y No* <br /> 12 Temp Rec at Lab <br /> (Acceptance range for samples ? <br /> requinn&thermal pres 4+/-2°C) Y /No* <br /> Sample Receipt!Log7 �. *If Circled, contact Project Manager and attach record of resolution. <br /> ���� <br /> Revision 2 1 (11/1:0/00) <br /> Replaces Revision 2(11/06!00) Page of <br />