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1 r I <br /> � w <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> F <br /> ENT NAME` ��� - DATE REC'D AT LAB [ I L �5 For Regulatory Purposes? i <br /> C.BY(PRINT) TIME REC'D AT LAB DRINK[NG WATI"R YES/NO ` <br /> JWC <br /> RKORDER. M0 L-ID(0 0�- DATE LOGGED IN. I� i «�$� WASTE WATER YES 1 NO , <br /> CLE THE XP;PROPRIATE RESPONSE LAB DASH CLIEN F Ib CONTAINER PRESERV pH SAMPLE DATE REMARKS- <br /> CLIENT <br /> EMARKS- € <br /> SAMPLE# # DESCRIPTION ATIVE MATRIX SAMPLED CONDITION(ETC) <br /> tody Seal(s) r@sen 1 Absent I <br /> 1n roken* <br /> 2 Chain-of-Custody Pres; Absent* <br /> 3 iTraffic Reports or <br /> ---Packlng List Ermnt <br /> 4 Airb€II Alrbill ticker <br /> ' Press /Absent <br /> 5 Airbill# <br /> 6 Sample Labels rese !Absent <br /> 7 Sample lDs €steel t listed <br /> a hairs-of-Custod <br /> 8 Sample Condition 6garoken*/ <br /> Leaking* <br /> 9. Does information on chain-of-custody, <br /> traffic reports and sample Iab <br /> agree? Ye /No* <br /> 10 Sample received within <br /> hold time? Q/No* <br /> 11 Adequate sample volume <br /> received? 1 No* <br /> 12 Proper preservatives used eV/No-1 <br /> ,13 rip Blan /Tem $tank R e <br /> s <br /> drela which.If es AV NO* <br /> 14 Read Temp <br /> Corrected Temp 4 " <br /> Is corrected temp 4+/-2'C7 No** <br /> (Acceptance range for samples requiring thermal pros) <br /> L:or <br /> eption (if any), METALS / DIFF ON ICE <br /> Problem COC <br /> y u <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD Ol"RESOLUTION <br /> j SRL Revision 7 <br /> I Re s Rev 5(47113/04) Page of <br /> t EfIr 07/18105 <br />