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LY i z<��i ALF if 1A K R Aw�L1V LOG <br /> Lab2�7– (l�t:rtl.ftlg %i ate.)for f�,�4 <br /> Y 1 i 1'11S1e <br /> lM O!� b <br /> - <br /> ��'t)Iili�r:',,z _. i`'1'l'>Lytcliate r)fuL <br /> regulatory purposes I'L'SIl<l <br /> CIRCLE TIME APPROPRIATE RESPONSE LAIC Dash CONTAINER SAMPLE DATE <br /> SAMPLE# # CLIENi ID DESCRIPTION pH MATRIX SAMPLED CONDITION (ETC.) <br /> � v � <br /> I Custod'v Seal(%) ese !Absent n <br /> r tlBroken* <br /> 2 Chain of-Custod resent/Absent' Z <br /> 3 Atrbrlt A—lll/Sticker <br /> Present <br /> 4 Airblll# <br /> 5 Sam le 1 abets rese t l Absent <br /> 6 Sample fns iste /Not,Listed ILL— <br /> on Chain-at-Custod �2r <br /> 7 Sample Condition ac !Brol en*! t <br /> Leal,tn ?�o <br /> 8 Does uilorm,ltton an custody reports, <br /> 2,70 <br /> traffic reports,and sample <br /> labels agree e /No la <br /> 9 Sarnple recelvaLl u=Ltlutl <br /> hold tune e /Noy` <br /> 10 Proper Preset vattves 3 '�y <br /> used /No* <br /> 11 l em erature Blank Recetved9 Yes <br /> 12 Temp Rec at Lab 5 C &g-tms c <br /> (At,Leptanc,e range for samples <br /> reyuutnb tberinal pLes W-2°C) /Noy` <br /> 13 Satrlples collected mole <br /> than 4 days a 70? Yes N <br /> rc u <br /> *If Ch sled, contact Project Mama er And attach record of resolution. <br /> Sample Receipt Log Page of <br /> Revlslort 2 2(8130/04) <br /> Replaces Revision 2 1 (11110100) FIGURE 6b <br /> Ellecltve 91 i�04 <br />