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I iJ <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG , <br /> A <br /> CLIENT NAME• DATE Received at Lab: (Dnnk,iog water)for <br /> REC. BY(PRINT) TIME Received at Lab: regulatory purposes. YES/NO <br /> WORKORDER: LOG IN DATE: (Wastewater)for <br /> regulatory purposes: YESINO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ED DESCRIPTION MATRIX SAMPLED CONDITION(ETC,) <br /> 1 Custody Seal(s) ktt, <br /> t l Absent <br /> �C <br /> /Broken* <br /> 2 Chain-of-Custod r e t/Absent* <br /> 3 Traffic Reports or <br /> Packing List Present/ <br /> l 4 Airbill Airbili 1 Stick <br /> Present/', sen <br /> # S Arrbill# <br /> 6 Sample Labels t/Absent <br /> 7 Sample lDs r 1 Not Listed <br /> on Chain-of-Custod n <br /> 8 Sample Condition to t/Broken*! G <br /> Lealun * 9V <br /> 9 Does information on <br /> custody reports, traffic <br /> x reports and sample <br /> labels a ree t Y 1 No* <br /> 10 Sample received witlun t <br /> k i a <br /> hold bine e 1 No* <br /> 11 Proper Preservatives f <br /> used 1 No* <br /> 12 Temp Rec at Lab - <br /> ; (Acceptance range for samples <br /> -rmu'.—Inng thermal pres 4+1-2°C) Y 1 No* <br /> *If Circled, contact P ject anager and attach record of resolution. <br /> Sample Receipt Log <br /> ReViSi0n21 (11110100) Page of <br /> Replaces Revision 2(11100100) ` <br /> Effective 11/12100 <br />