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arc <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> YdM r <br /> CLIENT NAME DATE Received at Lab Il (D;okwaer.)rftrt <br /> RE BY(PRINT) <br /> TIME Received at Lab �a� regrpses YES <br /> WORKORDER _� LOG IN DATE 31 Cj (Wfoa <br /> regrposes Y /N <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE# CLIENT ID DESCRIPTION MATRIX SACONDITION(ETC.) <br /> 1441 co <br /> 1 Custody Seal(s) Present n w--) <br /> s <br /> Intact/Broken* <br /> 2 Cham-of-Custody rp:" t 1 Absent* `~3 <br /> 3 Traffic Reports or <br /> Packuig List Present/ <br /> 4 Airbill Airbill/Stic er ' <br /> Present <br /> 5 AirbilI# 1 <br /> 6 Sample Labels resent/Absent Dq <br /> 7 Sample IDs /Not Listed <br /> on Cham-of-Custody <br /> 8 Sample Condition tac /Broken*/ <br /> eakm <br /> 9 Does uiformation on <br /> custody reports,traffic <br /> reports and sample <br /> 1 labels agree? s No <br /> 10 Sample received within <br /> hold time No* <br /> 11 Proper Preservatives <br /> used e /No* <br /> 12 Temp Rec at Lab <br /> (Acceptance range for samples <br /> re uirin thermal res 4+/-2°C) Yes/No* MUM M <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> 1 <br /> Sample Receipt Log <br /> Revision 2 f (11/10100) page of <br /> Replaces Revision 2(11/06100) <br /> Effective 11/12100 <br />