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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIEN i NAME- _ DATE Received at Lab .� /�.f�o[� (DriuWng water)for <br /> REC.BY(PRINT) TIME Received at Lab _ �� � regulatory purposes. YES/NO r <br /> WORKORDER. 1912. LOG IN DATE (Wastewater)for <br /> Y <br /> regulatory purposes: YES/NO <br /> i CIRCLE THE APPROPRIATE RESPONSE LAB Dash CONTAINER SAMPLE DATE k <br /> SAMPLE# # CLIENT ID DESCRIPTION pH MATRIX SAMPLED CONDITION(ETC.) <br /> t Custody Seal(ti) e t/t q -� <br /> r n t/Broken* 1-7 9Ir IV <br /> # 2 Chaui-of-Custody t/A nt* <br /> x <br /> 3 Airbill AirbillI r <br /> e nt/Absent 4 <br /> R <br /> x 4 Airbill# <br /> 5 Sam ie Labels es t/Absent t <br /> j 6 Sample IDsl�d/Not Listed <br /> oil Chain-of-Custody <br /> i 7 Sample ConditionIn t/Broken*/ <br /> F Leaking* <br /> 8 Does information on custody reports, <br /> traffic Ieports,and sample <br /> labels a e'? 1 No* <br /> 9 Sample receLN ed within <br /> hold time Y /No* <br /> 10 Proper Preservatives <br /> used a/No* x <br /> 11 rein erature Blank Received s/No* <br /> 12 temp Re(, at Lab , &g—c r <br /> (Acceptance range for samples <br /> re titrin thermal pies 4-t-/-2°C Vs/No* <br /> 13 Samples coiletted Vlore <br /> than 4 da s ago Yes *I <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revtsion 2 2(8130104) Page of <br /> Replaces Revision 21 (11/10100) <br /> Ftfar hva 911'04 FIGURE 6b <br />