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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> EMS=ZFEIrr <br /> sL� DATE Received at Lab. i �2— t (Drinking water)for a <br /> r CLIENT NAME• <br /> TIME Received at Lab: C3 r,,- '� regulatory purposes: YF <br /> A& <br /> BY(PRINT) I& <br /> ` {Wastewater)for <br /> i WORKORDER: 2. 1 r LOG IN DATE: � <br /> ' regulatory purposes: YES Q <br /> CONTAINER SAMPLE DATE <br /> CIRCLE THE APPROPRIATE RESPONSE LAB Dash <br /> SAMPLE# # CLIENT ID DESCRIPTION pH MATRIX SAMPLED CONDITION(ETC.) <br /> 1 Custody Seal(s) Present 'Abse <br /> Intact 1 Broken* <br /> r <br /> 2 Chain-ot-Custodyres nt I A ent* <br /> 3 Airbitl r / <br /> r esit 1 Absent <br /> i <br /> -7 21- <br /> 5 <br /> 5 Sam le Label, I Absent Y <br /> 6 Sample IDs st I Not Listed <br /> on Chain-of-Custody <br /> f 7 Sample Condition tW1 Broken*1 <br /> � <br /> Leaking* <br /> 8 Does information on custody reports, <br /> traffic reports,and sample t <br /> labels agree? 1 No* <br /> fi <br /> 9 Sample received within <br /> y hold time /No* <br /> , 10 Proper Preservatives `� 'yy~ <br /> used Lk 1 No* <br /> l l tem erasure Blank Received ! <br /> 12 temp Rec at Lab 3 <br /> z <br /> (ALc.eptance rwige for samples <br /> Nqffirin&thermal pres 4+1-2°C) Ye !No* <br /> 13 Samples collected more <br /> than 4 da s a 0 Yes" <br /> mF V'1r SYMY NC s <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revlslon 2 2(WO/04) Page of <br /> Replaces Revision 21 (11/10/00) FIGURE 6b <br /> ris....F .,Of I fllA <br />