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_ SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: tap DATE Received at Lab: ) (Drinking Nater) for f <br /> REC BY (PRINT) TIME Received at Lab: regulatory purposes. YESINO <br /> WORKORDER LOG IN DATE. k,2 ,J (W istewater)for <br /> regulatory liltiposev YESINO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> i <br /> SAMPLE ' I# CLIEN I'ID DESCRIPTION MATRIX SAMLED CON UtI lUN (ETC) <br /> 1 Custody 5cal(s) YV <br /> Intact/ roken* <br /> 2 Challi-of-custodyesen Absent* --27 )9 <br /> 3 rraf!'ic Reports or b3-A <br /> Packing List Presen <br /> 4 Airbill Airbill/Sticker <br /> Present <br /> 5 AubilL# <br /> G Sample Labels reser Absent _- <br /> 7 Sample IDs Not Listen <br /> on Chain-of-Custody <br /> 8 Salllple Condilloll qMZRV Broken* <br /> _ <br /> Leaking* <br /> 9 Does nifotivattoti alt <br /> c.uslody reputts, traffic <br /> repolls and sample <br /> labels a ree 1 e No* <br /> 10 Sample rcceived within — <br /> hold tutee /No* <br /> i I Proper PresLwatives -used e 1 No* <br /> 12 Temp Rec at Lab , <br /> (Acceptance range for saitiptes <br /> rec utrin thei toil rtes 4+/-2°C) Ye 1 No* <br /> i ... 1t.✓�.i w ,s. n v t H. wr <br /> *If Circled, contact Project Matta er ante attach t ecotcl of resolutioit. I <br /> Sample Receipt Log <br /> Revision 21 (1 tlt0/oo) Pae of <br /> Replaces Revision 2(11/0&00) � ���� <br />