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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> A DATE Received at Lab' (Drinking water)for <br /> CI IEN 1 NAME. cx, <br /> TIME Received at Lab regulatory purposes. YES9 <br /> REC.BY {PRINT? (wastewater)for <br /> 8VORKORDER LOGIN DATE: <br /> regulatory purposes: YES4 <br /> CIRCLE THE APPROPRIATE RESPONSE LAB Duh <br /> CONTAINER SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION pH MATRIX SAMPLED CONDITION(ETC) <br /> Mw-1W <br /> 2 <br /> i Custudy seal(s) Prese Abd I <br /> Intact I Broken* <br /> Z Chatil ut-Custod rese 1 Ab nt* <br /> I Aubill S c <br /> es ut 1 Absent <br /> 4 Aubill# 6Q �� �� � <br /> S Simple Labels rose 1 Absent <br /> b S unple Ips ed!Not Listed <br /> on Chain-of-Custody <br /> 7 Sample Condittuw nta l!Blaken*/ <br /> Leaking* <br /> 8 DOES iillui iiiatton nn custody reports, <br /> ttattlL sipuits, asci sample <br /> labels a ILCE a No* <br /> 9 Saiiiple ieccned within <br /> hold time s I No* <br /> 10 Plupei Presci vahves <br /> used �` s 1 No* ; <br /> 11 lein eiatuie Blank Received 'I No* <br /> 12 Temp Rt,(. it Lab dem`6 <br /> (Aa.eptante rangi:101 sarrlples <br /> tet uwil thermal teb 4+1-2°C) Qs 1 No* c <br /> i <br /> 13 Wllttted wore <br /> Hiatt 4—'tb ago', Yes *106 <br /> v ,, T ,ri <br /> *If Circled, contact PraJect Manager and attach retard of tesolution. <br /> sar,F j,nuc epi Log Page ~�0 <br /> f �:VESfnI i d L 18/30!043 <br /> fteptaues Revision 2 1 (11/10100) FIGURE$b <br /> i_n, ,, i1 S 0o <br />