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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME DATE Received at Lab 3 (Drinking water)for <br /> RLC BY(PRINT) �',�^ _ TIME Received at Lab �D regulatory purposes YE ANO~ <br /> WORKORDER LOG IN DATE —6 (Wastewater)for <br /> regulatory purposes YE I /NC <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC) <br /> I Custody Seal(s) Present en ` () <br /> Intact/I3r <br /> 2 Cham-of-Custodyes t/Absent* <br /> 3 Traffic Reports or <br /> Packing List Present sen s <br /> 4 AirbiIl A►rbill/Sticker (� <br /> Present/ en --� <br /> 5 Airbill# <br /> 6 Sample Labels e6t/Absent <br /> 7 Sample IDs is /Not Listed <br /> on Cham-of-Custod <br /> M <br /> 8 Sample Condition ntac /Broken*/ <br /> eam * <br /> 4 Does information on <br /> custody reports,traffic <br /> reports and sample <br /> labels agree? es/No* <br /> 10 Sample received within <br /> hold time §—esy No <br /> 1 I Proper Preservatives <br /> L(Acceptance <br /> d e /Na* <br /> mp Rec at Lab Ci <br /> range for samples <br /> thermal res 4-r/-2p Yes/No* <br /> *If Circled, contact Protect Manager and attach record of resolution <br /> Sample Receipt Log <br /> ReWslon 2 1 (11/10/00) <br /> Replaces Revision 2(11106100) Page of <br /> Effective 11/12/00 <br />