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! i • <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME. <br /> RE' (DI inking Nater) for <br /> HATE Received at Lab; x r y <br /> C. go <br /> I3Y (ERINTIME Received at Lab, regulatory purposes. YESINo�VORKORIIER• LOG IN DATE: 3 <br /> (Wastewater)for <br /> 5 <br /> regislatory purposes. YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE I LAB ----------------------- <br /> SAMPLE DATE <br /> SAIIIPLE# # CLIENT ID DESCRIPTION MATRIX SA111111 ,ED CONDITION(ETC) <br /> I Custody Seal(s) ut/Absent <br /> nt cl/Broken* <br /> Chain-of Cnstod P /Absent* <br /> 3 Trallic Reports or <br /> Packing List Present LA0e <br /> 4 Asrbsl! Alrbill/Sticker <br />� Present/ set t <br /> S Aubsil# <br /> G Sample Labels P e t/Absent <br /> 7 Sample IDs s /Not Listed <br /> on Cham-of Custod <br /> 8 Sample Condition I t t/Broken*/ <br /> Leaksn # Q <br /> 9 Does isifonnatson on <br /> custody reports, traffic <br /> reports and sample t <br /> hbeis a reel !No* <br /> 10 Sample received wsthiJs <br /> bold time 1 No* <br /> H 1 Pi oper Preservatives <br /> tEsed /No" <br /> Q. Rmp Km 11L Lab <br /> ;Acceplance range for samples <br /> M utl 1119 thel 111,11 tires 4+/-2°C) /No* <br /> - ti M <br /> *If Circled, contact P,oje 'I, is and attach record of resolution. <br /> Sample Rocelpf I og <br /> rZwwi,is I mtio lnl <br />