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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME• DATE Received at Lab: (Drinking water)for <br /> REC.BY(PRINT) TIME Received at Lab: _ regulatory purposes YESINO <br /> WOAKORDER. OJ' LOG IN DATE. — --O (Wastewater)for <br /> regulatory purposes- YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC) <br /> I Custody Seal(s) Present Absen A"?— (A. -� <br /> Intact I Broken* <br /> 2 Chain-of-Custody Present Absent* lir 4 A,- <br /> 3 Traffic Reports or <br /> Packing List Present/ sent <br /> 4 Airbill Aubill I S <br /> Present/it <br /> 5 Airbill# <br /> 6 Sample Labels rese /Absent <br /> 7 Sample IDs List /Not Listed <br /> on Chain-of-Custody <br /> 8 Sample Condition Inti /Broken*/ <br /> Leaking* <br /> 9 Does information on <br /> custody reports,traffic <br /> reports and sample <br /> labels agree? Yes No* <br /> 10 Sample received within <br /> hold time Ye 1 No* <br /> 11 Proper Preservatives <br /> used s 1 No* <br /> i <br /> , 12 Temp Rec at Lab <br /> 3 <br /> (Acceptance range for samples <br /> regutnng thermal 2res 4f1-2°C) l No* <br /> "77 177777— <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log \ <br /> Revision 21 (11/10/00) <br /> Page of <br /> Replaces Revision 2(11/WOO) <br />