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• r <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: � DATE Received at Lab. �M_ �7' � <br /> � (Drinking water)for <br /> REC.BY(PRINI) TIME Received at Lab: Z 43 6—D regulatory purposes: YESfNO <br /> WORKORDER: ZZd — LOG IN DATE: 1Zf�((� (Wastewater)for <br /> - - y <br /> regulatory purposes: YESINO <br /> � rY P EP <br /> s <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> t <br /> SAMPLE# # CLIENT ll3 DESCRIPTION MATRIX SAMPLED CONDITION(ETC.) <br /> 1 Custody Seal(s) rese I Absent 1 Z�1- 0 <br /> &wntal Broken* <br /> 2 Chain-of-Custody Presen /Absent* <br /> 3 Traffic Reports or <br /> PackinE List Present/A ent <br /> 4 Aubili Sticker <br /> Pres t/Absent <br /> 5 Airbill# <br /> 6 Sample Labels Presen /Absent <br /> 1 Sample IDs rst Not Listed <br /> on Cham-,of-Custody <br /> 3 8 Sample Condition luta 1 Broken*/ <br /> a <br /> Leaking* <br /> 9 Does information on <br /> custody reports, traffic <br /> reports and sample <br /> labels a ref Y '!No* s <br /> 10 Sample received within <br /> hold tune es No* <br /> 11 Proper Preservatives a <br /> used Ye No* <br /> 12 Temp Rec at Lab �. <br /> (Acceptance range for samples <br /> r uirin thermal res 4+1-2°C Ye .No, <br /> w N, <br /> *If Circled, contact Protect Manager and attach record of resolution. � <br /> Sample Receipt Log <br /> Revision 21 (11/10100) <br /> Replaces Revision 2(11106M) Page �� <br /> ru----44I4AM <br />