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i <br /> SEQUCLI ANALYTICAL SAMPLE Xt_IXY]P I-I.OG <br /> - <br /> CLILMI NAMT: C <br /> `` � n DATE Recelved at Lab: �� ) (DTinking water)for �� <br /> RRC.BY(PRIN'i') TIMERccclvU]at Lab, � � reg«la#o�y Purposes- Y `� <br /> WORKORDER: _., `t ,c�] LOG IN DATLO. - { (Wastewater)for <br /> regulatory pw pages- Y <br /> CIRCLE THE APPROPRIATE RRSIPONSE LAR SAMPLE DATL+ <br /> SAMPLE 9 # C J,IFfNT 1D I)YSCIOVI TON MATRIX SAMPLED CONDITION(RTC.) <br /> 1 t,WOdy Ses](s) Mstill{Abe <br /> intact f Rm <br /> 2 Cbnin-of-ClistDdy tw,s ib Absent* <br /> 3 Traffic Reports or <br /> Parking x Ist: Present 1 a <br /> 4.Airbill Abbill! er <br /> - Presefit 1 e� <br /> 5 Airbiliff Coo <br /> 5 SaRIP It.1 abels resen t I Abs�tjit <br /> i <br /> 7 Sample JDs Mot Listed <br /> an Cliain ofCustod <br /> 8 Sample Condition its DmkcuA! - <br /> g# <br /> 9 Does i>Ormatioa on <br /> custody reports, traffic <br /> reports and sample F <br /> labelsagree? No* <br /> 10 Sample received within <br /> hold tone Ka* lor <br /> y <br /> t t.Proper PrCs4'.rY$T1VCs <br /> used /No• <br /> 12 Temp Ree at 1A <br /> (Acceptnuce onge for samples <br /> re <br /> tio.thermal a 4+/-2'9, 'Yas IMa* <br /> *If Cit ciccl,cantfjt t Project Manager anti attach rccoi d of r esoluiion. <br /> SawpTe tiereTpt Log <br /> Rovislvn 21 (1111 NM) Page <br /> RejjW Revlslan 2(11 M=) — <br /> ETMW 11112100 <br />