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• 0 0 <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> r <br /> t CLIENT NAME. �-� , } DATE Received at Lab: {dna (Drinking water)for <br /> REC, BY(PRINT) TIME Received at Lab: regulatory purposes. YESINO <br /> t WORKORDER: LOG IN DATE: <br /> (Wastewater)for <br /> regulatory purposes: YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC.) <br /> 1 Custody Seal(s) Present/ bsent <br /> i <br /> I /Broken* <br /> 2 Chain-of-custody res t/Absent- <br /> 3 Traffic Reports or <br /> 2 <br /> Packing List Present/ bsej <br /> 4 Airbill Airbill/StPkTIM <br /> Presen Abse <br /> 5 Airbill# ' <br /> 6 Sample Labels /Absent = <br /> 7 Sample IDs is d/Not Listed <br /> on Chain-of-Custody <br /> 8 Sample Condition n t/Broken*/ it)M <br /> Leaking* Ib� <br /> " 9 Does information on <br /> custody reports, traffic <br /> reports and sample t <br /> labels a ree? e /No* <br /> 10 Sample received witlun } <br /> hold time e I No* <br /> I I Proper Preservatives ff <br /> used I No* € <br /> r <br /> 12 Temp Rec at Lab { <br /> (Acceptance range for samples <br /> requinng thermal res 4+1-2°C) es No* <br /> *If Circled, contact Pro ect Mana er and attach record of resolution. <br /> Sample Receipt Log <br /> Revlsion 21 (11110/00) <br /> Replaces Revision Z(11/06!00) <br /> F Page of <br /> I <br />