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SEQUOIA ANALYTICAL SAMPLE RE,CEIPT LOG <br /> CLIENT NAME ��Q-� <br /> DATE Received at Lab JA (Drinking water)for <br /> REC BY(PRINT) _ _ TIME Received at Lab d regulatory purposes <br /> WORKORDERLOG IN DATE (Wastewater) for <br /> regulatory purposes Y /NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC) <br /> t 1 Custody Seal(s) Present/ sent <br /> Intact/Broken* aa ^ <br /> 2 Chain-of-Custod res 1 Absent' D ^ C <br /> 3 Traffic Reports or —ULA ` <br /> Packing List Present/ 3 <br /> 4 Airbill Airbill/ er <br /> Present/ <br /> S Airbill# <br /> 6 Sample Labels t/Absent <br /> 7 Sample IDs st /Not Listed i <br /> on Chain-of-Custody <br /> 8 Sample Condition nta I Broken* <br /> Leaking* <br /> 9 Does information on <br /> custody reports,traffic <br /> reports acid sample <br /> labels agree? es No* <br /> 10 Sample received within <br /> hold time es No* <br /> 11 Proper Preservatives <br /> used es No* <br /> 12 Temp Rec at Lab <br /> (Acceptance range for samples <br /> I <br /> requiring thermal pres 4+/-2°C) Yes 1 No* r <br /> *If Ch Bled, contact Project Manager and attach record of resolution <br /> Sample Receipt Log <br /> Revision 2 1 (11110100) Page of <br /> Replaces Revision 2(11106100) <br /> Effective 11/12/00 <br />