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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> MEN I'NAME: _ DATE Received at Lab. -I/-4 (Drinking water)for <br /> R)i:C BY(PRINT) TIME Received at Lab: � e regulatory purposes: YES/NO <br /> o[� (Wastewater)for <br /> vVl3tiK©KD�.H LOGIN DATE.,1�� / _��/— .— 4 <br /> regulatory purposes: YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAD SAMPLE DATE p <br /> SAMPLE# 4 CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC) <br /> 1 Custody Seals) <br /> r4iit/ �"� 61-� <br /> i <br /> n t/Bro en* <br /> 2 Cl iaiii-of-Custod t/Absent* <br /> z <br /> 3 1 rallic Rcpoits or <br /> Paikmg List Present/ ser } <br /> 4 Airbill Airbill/S <br /> Present/A en ilp <br /> 5 Aubill# //77 <br /> 6 Sam lc.Labc,ls res t f Absent /0/'7 <br /> 7 Sample IDs CIS*/Not Listed <br /> on Chain-of-Custody £ <br /> 8 Saiilple Condition t l/Broken"/ jo } <br /> Leaking* <br /> 9 Dues information on <br /> c.Eistodf reports, traffic <br /> reports and sample <br /> labels a iee7 es No* <br /> 10 Sample imerved within � c <br /> hold tiiiic &I No* <br /> 11 !Toper Preservatives <br /> Itsc� <br /> QiNo* <br /> . 12 Temp Rec at Lata <br /> (A xcptanLc range for samples <br /> e uu if►�thermal res 4+/-2.°C) s/No _ <br /> *If Circled, contact Project Manager an,d attach record of r 'on. <br /> Sample Receipt Log <br /> Revision 2 1 (11110100) <br /> Page of <br /> Replaces Revision 2(11106M) <br /> ",—, ... .,,,.., <br />