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mom mmi � mm <br /> SE U01A ANAf YTIC AL SAl11'1',J1; RECk:11141,0 C; <br /> CLIIlI`T'1'ArhMJs: _ DATE W-Mved at Lai):' (Dr➢nking water)fnr <br /> RE . uy(1'lilh'1'J (moi T01L licecived nt Lab: ( regulatory purposes: YLS _ <br /> WORKOMER; LOG IN JyATE; (Witstewater) for ~JJ <br /> regulatory purposes: y ' ND <br /> Cl1ZOY THE A,A'1'1 OPMA.TF I SPONSE LAB SAMPLE DATE <br /> SAMPLE 9 # CLII NTID DESCRIPTION MATRIX SANITLED CONDITION(LTC.) <br /> 1. {study SCSI(S) Present! en S 0 L <br /> Tntact!l3ro en r (} <br /> 2. Chain-of-Custody re Ut!Absent* Y <br /> 3. T`-afl3c Reports or [I <br /> Pack' List: Present I sen <br /> 4. Airbill: A1rbiIIIStic r ' <br /> { <br /> Present 1On <br /> 5. Airbill #: <br /> 6. Samn to Labels: qs /Abseul <br /> 7, Sample Ills: -` — 'Not l.isml <br /> I am am-af-Custod � 4 ti <br /> 8. Sample coaditian: to Broken*! -� f ✓ <br /> e E <br /> 9. Does information on <br /> custody reports, traffic <br /> reports and sample <br /> labels agree? e 1 No* <br /> 10. Sample received within <br /> hold time: e N& <br /> 11. Proper Preservalives <br /> I <br /> used: c No* <br /> 12. `1'einp Rec.at Lab: 1 <br /> (Acceptance range for samples <br /> uirin 41erina1 res.:44-1--2°C) Yes 1140* <br /> *If Circled, coll(tef Project Manager and attach retard of re'solution. <br /> Sample ReoaTpt Log <br /> Revislon 2.5 (W10100) <br /> Replaces Revision 2(t i1 MO) Page of <br /> Effar&a S ill Mo <br />