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SEQUOIA ANALYTICAL SAMPLE RE Eirr LoG <br /> CLIENT NAl1i> UA"I'F; Received at Mh, (Driuking water)for <br /> I <br /> ITEC. BY (PIUNT) TTNFF Received at Lab- 1A regulatory purposrs: <br /> W(IRKORDFR: LOC 13`I]7A'I P: (tiVasiclfatcr) for <br /> reguratory purposes: Y <br /> CIRCLE TILE;APPROPRIATE RESPONSI; LAU SAE4IPLE DATE <br /> S,4147PJ.Tt# # CLIENT ID I)MC1iI PTION 61ATRIX SAMPLED CONDiTJON(FT.'.) <br /> 1. Custody seals) present 1 sent <br /> �S i <br /> Tip jAbseat* <br /> 2. Chaimvf-Ctistrxiy Presen 3. Traffic Reports orPackin ;List: Present,4. Airbill: Aibiil l L <br /> Freseitt on <br /> 5. �Sirbili I(: — 3 5 <br /> 6. Sxm to Labols: /Absent <br /> 7. Sample rDs: J Not Lisfed <br /> on C:hxin-of-Custody <br /> i <br /> S. Sample Condition: 1 13rokcn°1 <br /> in <br /> 9. Does inFonnation on <br /> custody rcpor(s,fraffic <br /> reports and sample <br /> lRbels a c? G/No, <br /> 10. Sample received witblu <br /> hold tube: e. 1 No' <br /> 1 t_ Proper Preservatives ; <br /> used: es NO,* <br /> 12. Temp Rec,at I tb: lq, ° <br /> (Acceptance rango for samples <br /> jrequiring tuemial res.=44-!-2'C Yes I No* <br /> *If Circled, confact Project Manager and at(aeh record of resoiuiian. <br /> Sample Receipt Log <br /> Revislon 2.1(1'81(OO) <br /> Replaces Revision 2(11*5=) <br /> Page 4f <br /> EoecJ"11112100 <br />