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_ SEQUOIA ANALYTICAL SAMPLE RECEIPT-LOG - <br /> CLIENT NAME: S - DATE RECD AT LAB: f r' -0" - For Regulatory Purposes? ..i. <br /> TIME RECD AT LAB: 'f!S DRINKING WATER YE <br /> IREC.BY(PRINT) ... lam' 7 -- <br /> 'WORKOFiD R: a f�' .2 DATE LOGGED IN; _T �/ f= WASTE WATER Y`~ NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRE ERV SAMPLE DATE•.. nEmARKS: <br /> SANI['LE# # CLIENT ID DESCRIPTION ATIVE PH MATRIXSAMPLED. CONDITION(ETC.) i <br /> 1, Custody Seal(s) Pr@sen til4 EZIJ" ~ yn&h X,f 19WA " �� t <br /> Intwt Broken* C, <br /> 2.Chain=of"Custod res t 1 Absents n <br /> 3.iPfalficReportsor O-V <br /> Packfn List: Present b &7 ��Z aS �torx- l C Cr <br /> 4. Alr&1.: Sticker Ji S P'rq-�a r1Qu j W/k, <br /> l Pr t/Absent em <br /> . 5. Airbill fi: � 6 � • Uacr� j <br /> 6. Sample Labels: res - t 1 Absent 6 ... s w-/ �z� <br /> 7.-Sample IDS: <Vs a /Plot Listed <br /> on Chain-of-Custod <br /> 8..Sample Condition: rata I Broken*I <br /> Leakl n <br /> 9.;Does information on chain-of-custody, <br /> traffic reports and sample labels <br /> a ree? 1 No* ' <br /> 10. Samplo.received within <br /> hold time? e 1 No* <br /> 11. Adequate sample volume <br /> received? �Q1 N6- <br /> 12. Pro or gresased? 6V1 Pio* <br /> 3.7rlp blank Temp Blank ceived? <br /> (circle Alch,if es /No` <br /> I4.;Read Temp: , <br /> ,Corrected Temp: G <br /> ,Is corrected temp 4+1--2"C? 5 /No*" <br /> tAccaptance range for samples requiring thermal pros.) <br /> "Exception(if any): MECAL,S ! DFF ON ICE <br /> or Problem COC <br /> f *IF CIRCLED;CONTACT PROJECT MANAGER AND ATTACH RECORD Of✓RESOLUTION. <br /> SAIL Rovlslon 7 Page at/ <br /> floplaces Rev 5(07113/44) ; <br /> 1 ffecliva Q7119105 ` I t....� �...W� L-: L— <br /> L....� <br />