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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: DATE Received at Lab: V?l a Drialdng water for <br /> REC.BY(PRINT) e <br /> TIME Received at Lab: regulatory purposctc: YES l NO <br /> WORKORDER: LOG IN PATE: Wastewater for ' <br /> regulatory PUrPOffV-/ yFASINO <br /> CIRCLii:THE APPROPRIATE RESPONSE LAB CONTAINER SAMPLE DATA: REMAIL: <br /> t'sAMPLE# # CLIENT ID DL I N MATRIX SAMPLE O D ON <br /> I. Custody Seals) Prrseat <br /> intact 1 Broken* <br /> 2. Chain-of�stnd Prese:it AbsentR <br /> 3. Traffic Reports or <br /> PackingList: Present se t <br /> 4. Airbill. Airbiil/ r <br /> l'resetit/ <br /> S Aidmil P <br /> 6. Sara le Labels t/Absent <br /> 7 Sample IDsst Not Listed <br /> on Chaffs-of-GtsEod <br /> 8. Sample Condition =-11rokW/ <br /> 9. Does information on _ <br /> custody reports,traiiie ' <br /> imports and sample <br /> IRbels e 7 /Nn* <br /> 10. 5aittpla recelvrd within <br /> bald tune' Nn* <br /> 11. Prnpbr Preservattvms <br /> used Y /No* <br /> I2. Temp Rec.at Lab. 1 <br /> Is temp 4+/-rC? /Na"* <br /> (Accepbuicx range for samples requiring thermal pres.) <br /> **Bx+cg110 t(ifany).Metals/DFF cut 1ce7I DFF no ice? <br /> or Problem COC <br /> am"R—hA tea *If Circled contact P't'o ect Manager and attach record of resolution. <br /> Revision 2.3(1 2rMAq <br /> Rq as m Revistan 2.1(WJM2) Pago or <br /> -TI(JeW ro t2r241M <br />