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• , i <br /> SEQUOIA ANALYTICAL SAMPLE RECENT LOG <br /> b N � rr <br /> CLIEN I NAME: s DATE Received at Lab: .2/ l6 (Drinking water)for <br /> REC. BY(PRINV Q TIME Received at Lab: !D e-- regulatory purposes, YES/NO <br /> WORKORDER: LOG IN DATE: 'L n <br /> (Wastewater)for <br /> regulatory purposes- YES/NO <br /> CIRCLE I HE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC.) <br /> 1 Custody Seal(s) rest /Absent /AI t. <br /> nta Broken* rel ' / <br /> 2 Cliam-of Custod Present Absent* <br /> 3 Traffic Reports or <br /> Packing List Present I <br /> 4 Airbill 4G-4—a Sticker <br /> resen Absent <br /> 5 Airbill# <br /> r <br /> 6 Sample Labels 'Pre a /Absent <br /> 7 Sample ll7s ist Not Listed <br /> on Chain-of-Custody <br /> 8 Sample Conditioli tttac 1 Broken*1 <br /> Leaking* <br /> 9 Does information on <br /> custody reports,traffic <br /> reports and sample <br /> labels agreed e5 No's <br /> 10 Sample received within <br /> hold time Ye /Na* <br /> 11 Proper Preservatives <br /> fi used Y No* <br /> 12 Temp Rec at Lab <br /> (Acceptance range Far swriples <br /> re uirin tftermal pres 4+/-2°C) Yes No* <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> i <br /> Sample Receipt Log <br /> Revlston 21 (1111 010G) <br /> Replaces Revism 2(11106M) Page of <br /> Effective 11112MO <br />