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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: DATE Received at Lab: 4-1910 (Drinking water)for <br /> REC. BY(PRINT) TIME Received at Lab: regulatory purposes: YES/NO <br /> WORKORDER: U 2 LOG IN DATE: (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) Present, `'3)( <br /> Int /Broken* <br /> 2. Chain-of-Custodyese /Absent* <br /> 3. Traffic Reports or <br /> Packing List: Present <br /> 4. Airbill: Airbill/rSticker <br /> Present/ <br /> 5. Airbill#: <br /> 6. Sample Labels: /Absent <br /> 7. Sample IDs: Not Listed <br /> on Chain-of-Custody <br /> 8. Sample Condition: to /Broken*/ <br /> Leaking* <br /> 9. Does information on ' <br /> custody reports, traffic <br /> reports and sample ' <br /> labels agree? e No* <br /> 10. Sample received within <br /> hold time: e /No* <br /> 11. Proper Preservatives <br /> used: /No* <br /> 12. Temp Rec. at Lab: <br /> (Acceptance range for samples <br /> -: <br /> requiring thermal res.:4+/-2°C) e /No* <br /> a--, <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revision 2.1 (11/10/00) <br /> Replaces Revision 2(11/06/00) Page of <br /> Effective 11/12/00 <br />