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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: fP DATE Received at Lala: � '/ �3 (Drinking water) for <br /> RE,C. BY (PRINT) TIME ReLc►ved at Lab: t � regulatory purposes: YESINU <br /> WORKORDER. LOG IN DATE: S (Wastewater) for <br /> regulatory purposes: YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT iD DESCRIPTION MATRIX SAMPLED CONDITION{ETC.) <br /> 1, Custody Seal(s) Prese / seut <br /> AV <br /> I Bra en* a <br /> 2 Cliu►-ofGustocl re 1 Abse;itk <br /> 3 Traflic Reports or --T--- r <br /> Packnig List Present Ab ► <br /> 4 Airbill Airbill l Sticker <br /> (� x <br /> t Presen <br /> S Airbill# G <br /> G Sam le Labels or=x/Absent <br /> 7 Sample IDs /Not Listed <br /> o Ch ii-of-Custody <br /> 1 8 Sample Condition t 1 Broken* 1 <br /> t <br /> Leaking* <br /> i k <br /> z <br /> , 9 Does information on <br /> i <br /> custody reports, ttaClic <br /> reports and sample <br /> i t <br /> labels a ree? /No* - <br /> 10 Sample received within <br /> hold trine I No* <br /> r11 Proper Preservatives _ <br /> tised 1 No* <br /> 12 Temp Rec at Lab L/NNo*:L <br /> (Acceptance range for samples <br /> I thermal res 4+/-2°C) e <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br />