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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> v�,s DATE Received at Lab: l`rt (Drsaking water)(or <br /> CLIENT NAME. regulatory purposes YES/NO <br /> REC BY I) r TIME Received at Lab: <br /> - tTO LOG IN DATE' <br /> 6-- f J,f—o (Wastewater)for <br /> WORKORDER• regulatory purposes: YES/NO <br /> gu ry p rP <br /> CIRCLE THE APPROPRIATE RESPONSE LAB <br /> SAMPLE DATE - <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX S LED CONDITION(ETC) <br /> I Custody Seal(s) Absent <br /> E <br /> nta /Broken* <br /> 2 Chain-of-Custod resen /Absent* <br /> 3 Traffic Reports or <br /> Packirig List Present/ bsent <br /> 4 Airbill rbill Sticker <br /> ese !Absent <br /> 5 Airbill# D/D01 <br /> 6 Sample Labels rese Absent <br /> 7 Sample IDs ist Not Listed <br /> on Chain-of-Custody <br /> 8 Sample Condition n /Broken*/ <br /> Leaking* �- <br /> 9 Does information on E <br /> custody reports,traffic <br /> reports and sample <br /> labels a ree? Q1 No* <br /> 10 Sample received vntlun <br /> hold time Y /No* <br /> 11 Proper Preservatives <br /> used I No* <br /> 12 Teinp Rec at Lab <br /> (Acceptance range for samples <br /> requiring thermal pres 4+/-2°C) Ye /No* <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log page of <br /> Revision 2 1 (11110/00) <br /> Onnl�nee Gou+�+nn 7 11 11(PJnn) <br />