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SEQUOIA ANALYTICAL SAMPLE RECEIPT-LOG <br /> DATE RECD AT LAB:__!2_- -©5 For Regulatory Purposes?' <br /> ,.- .. ;.CLIENT-NAME:_, — � -.. . . _ _` G ER Y I <br /> ___-- ;, DRiK{N WAT ES/ <br /> REG.BY(PRINT) l' TIME REVD AT LAB: S—:_ - <br /> IWORKORDEi�: M b b DATE LOGGED IN: - 'D S WAST)r WATER YES 11 <br /> { <br /> •CIRCLE THE APPROPRIATE RESPONSE LAB DASH GON7AINER PRESERV SAMPLE DAT);,,. REMARKS: <br /> CLIENT ID". DESCRIPTION AWE pH MATRIX SAMPLED CONDITION(ETC.) <br /> SAMPLE# # <br /> 1.(Custody Seals) rq. I Abs rtt °' '"V =. 10 <br /> roken* uy <br /> 2. Chain-of-Custody res n)/Absent' <br /> 3.Traffic Reports or ' <br /> Packiln list: P bse 4 <br /> 4.`Afrbi l; Airbifl/ ticker <br /> I Absent f�tif' o <br /> rbill#: l <br /> 6.,Sam le Labels: res-en Absent <br /> 7..Sample lns: sted/ t Listed <br /> LA <br /> on haln-of-Gusto <br /> 8. Sample Condition: nta /Broken* <br /> Leaking* - <br /> 9. Does information on chain-of-custody, c <br /> traffic reports and sample lake <br /> e ree? XYesE No` r <br /> 10. Sample received within -e i <br /> hold time? Y /No* <br /> 11. Adequate sample volume <br /> received? a No* <br /> 12. Proper preserva es No* _1z <br /> 13. rip Blank Temp Blank Received? 3A1 <br /> r <br /> circle w e No* — <br /> 14. Read Temp: 13 13_Z1510_091470 <br /> Corrected Temp:_. <br /> Is corrected temp 4+/-2°C? Y@s/No** <br /> (Acceptance range for samples requiring thermal pros.) <br /> **Exmptiort(if any): METALS 1 DFF ON ICE <br /> or Problem COC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD 01=RESOLUTION. <br /> ' SRL Revlslon 7 Page - of <br /> Replaces Rev 5(07113104) <br /> • � jEifecllve 07/1 9105 <br />