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0 �r <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> ma <br /> CLIEN T NAhIE- r,e5 DATE Received at Lab, (Drinking water)for <br /> It.EC. BY(PRINT) — _ — TIME Received at Lab. �l�� Q- -_ regulator) purposes. YESINO r <br /> a <br /> �VUiti{t)KDlrH l41u / LOG IN DATE. _f/— (Wastewater)for <br /> regulatory purposes: YESINO <br /> i <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC.) <br /> I Custudy Seal(s) knt <br /> /Bro en* <br /> 2 Cham-of-Custud /Absent* <br /> 3 I ratlk, [reports or <br /> Pacl.tn=List__ Present 1 set s <br /> 4 Arrbtll A>rbill!S ; <br /> Present/A en <br /> 5 Aubrll# 1 <br /> 6 Simph,Labels res t/Absent <br /> 7 Sample IDs rs d/Not Listed <br /> on Chain-of-Custody <br /> 8 Sajnpk Conditions Gi t/Broken*I <br /> Lealan * <br /> 9 Duty information on <br /> i <br /> u►stod) reports, UaiDc <br /> reports and sample <br /> labels a =7 es No* <br /> 10 Sample 1eLetved v8itlttn 1 <br /> huld t1111c e !No* <br /> II Piopea Preservatrves <br /> t15��1 e I No* <br /> 12 Temp RCL at Lab <br /> s <br /> (Am,ptance range for samples <br /> lie u+r1U thermal res 4+/-2°C) s 1 No <br /> . 3 <br /> *If Circled, contact Project Manager and attach record of r6iAujjLn, <br /> Sample Receipt Log <br /> Revislon 21 (11!10100) <br /> Replaces Revislun 2(11106104) Page of <br /> -1- 1 -.- <br />