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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> r CLIENT NAME: S DATE Received at Lab. ".- sel (Drinking water)for <br /> REC.BY(PRINT) TIME Received at Lab: <br /> / regulatory purposes: YES/NO <br /> WORKORDER. <br /> LOG IN DATE; <br /> (Wastewater)for <br /> regulatory purposes- YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAS SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC.) ' <br /> 1 Custody Seal(s) resent Absent — — v <br /> Inta Broken* <br /> 2 Cham-of-Custnd Pres /Absent* <br /> 3 Traffic Reports or <br /> Packing hist Present/ sent --D <br /> 4 Airbtll Sticker <br /> Pres /Absent `5 <br /> s Airbtll# 3 <br /> 6 Sample Labels r Absent <br /> ' 7 Sample IDs is Not Listed c/o <br /> { on Chain-of Custod �o <br /> 8 Sample Condition to /Broken*/ <br /> Lealnn * �,S <br /> 9 Does information on _ J <br /> custody reports,traffic <br /> reports and sample o <br /> labels agree? e /No* <br /> 10 Sample received witluit <br /> k <br /> hold timeY /No* p <br /> t <br /> 11 Proper Preservatives <br /> used Yes No* <br /> 12 Temp Rec at Lab <br /> (Acceptance range for samples <br /> [,Ireqmnng thermal pres 4+/-2°C) es No* <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revlston 21 (11110/00) <br /> Replaces Revision 2(1 VOW= <br />