Laserfiche WebLink
SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: I�-� DATE RECD AT LAB f' •6,7-. For Regulatory Purposes? <br /> REC.BY(PRINT) <br /> TIME R>~C'D A7 LAB, 0-T S DRI t�KING WATER YES/NO <br /> WORKORDER. r7 . b�� DATE LOGGED IN, ( z�aS WASTE WATER YES/NCI <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV SAMPLE DATE REMARKS: <br /> SAMPLE# # CLIENT ID DESCRIPTION ATIVE pH MATRIX SAMPLED CONDITION(ETC) <br /> 1 Custody Seal(s) Present/ bsent <br /> t Broken* Z <br /> 2 Chain-of-Custody Pres /Absent" <br /> S Traffic Reports or <br /> PackingList P ent sen <br /> 4. Airblll �Alr Sticker <br /> s nt/Absent - <br /> 5 Airbill# ) Z.? <br /> 6 Sample Labels, resen 1 Absent <br /> 7 Sample 1Ds Liste /Not Listed �G ~ b <br /> hain-of-Custod <br /> e Sample Condition Inta t/Broken*I Zoo dct <br /> Leakln <br /> 111 <br /> Does information on chain-of-custody, <br /> traffic reports and sample labLs 1a ree? Y No*D Sample received within <br /> hold time? Ye /No <br /> 11 Adequate sample volume <br /> received? Y /No* <br /> 12 ro ree sed? <a;1/No* <br /> I r Trip BI n Temp Blan ece'vad? <br /> c l h if es 1 No* <br /> 14 Plead Tamp <br /> Corrected Temp , <br /> Is corrected temp 4+1-2*C? �Ye /No- <br /> (Acceptance range for samples requlring thermal pros) <br /> "Exception (If any) METALS I DFF ON ICE t <br /> DT Problem COG <br /> REMINOMEMEEM <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION <br /> SRI.fievlsfon 7 Page�„of <br /> Replaces Rev 5(07/13104) <br /> Effective 07/19/05 i <br />