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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME- _�t [ 0 DATE REC-D AT LAB G 1 Z�/p _ For Regulatory Purposes? <br /> REC BY(PRINT) TIME RECD ATLAS • 0 a DRINKING WATER YES <br /> WORKORDER: HOP 11 - DATE LOGGED IN: _ ¢.-F-Sc- o r WASTE WATER YES CW <br /> (For clients requiring preservation checks at receipt,document here ) <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CLIENT ID CONTAINER PRESERV pH SAMPLE DATE REMARKS <br /> SAMPLE# # DESCRIPTION ATIVE <br /> IIIIATHtX SAMPLED CONDITION(ETC) <br /> I Custody Seal(s) Present! AA w - 1 Va Dl- 3 H G I ~} L l <br /> Intact/Broken* µw 7- < <br /> 2 Chain-of-Custody t/Absent* 0W - 7 <br /> 3. Traffic Reports or MV 4 <br /> Packing List Present/ ? MW . T <br /> 4 Alrbill fl /Sticker �Aw C <br /> Present/Absent W <br /> 5 Afrbill# Ca N o D nv( op 5'ffS 1$3 6 6 " I <br /> 8 Sample Labels ifres t/Absent V/ . 2- <br /> 7 <br /> 27 Sample 1Dsste /Not Listed 3 <br /> on Chain-of-Custody <br /> 8 Sample Condition nt /Broken"/ W . S <br /> Leaking* VvJ G Lo o <br /> 9 Does information on chain-of-custody, VtiN• I 4— <br /> traffic reports and sample label VVV <br /> agree? a No* Vj ( 1 1e a S i <br /> 10 Sample received within Vw. 12 �l <br /> hold time? 6PI No* M -- <br /> ll Adequate sample volume AIS • \00 - <br /> received? <br /> liu - <br /> reeceived? /Ne An S - 2- <br /> 12 Proper Preservatives <br /> used? 62 No* A/1 - <br /> 13 Trip Blank/Temp Blank Received? M S• 3 <br /> circle which ff es Y /No" 150 06 47a- 1Tf1 Q- 2 71717K &110( <br /> 14 Tomp Rec at Lab 2,4 ac <br /> Is temp 4+/-2°C? Yes/No" <br /> (Acceptance range for samples requiring thermal pr I <br /> *"Exception(it any) METALS / DFF NIC tel <br /> or Problem COC <br /> 'IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION <br /> SRL Revision 6 !! <br /> Replaces Rev 5(081074) Page l 'Of , <br /> Effective 07/13104 <br />