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0 �. . <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG .. ... <br /> CLIENT NAME DATE Received at Lab: (Drinking water)for <br /> REC.BY (PRINT) <br /> TI1VIE Received at Lab: regulatory purposes: YE51N0 <br /> WORKORDER: D LOG IN DATE: CT (Wastewater)for <br /> regulatory purposes: YES/NO <br /> r CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC.) . <br /> 1. Custody Seal(s) r n e <br /> 1 Broken* <br /> 2. Chain-of Custod t I Absent* <br /> 3. Traffic Reports or �) ! <br /> Packing List: Present/Alfefat <br /> 4. Asrbill: 111 S r <br /> tk/Absent <br /> 5. A.irbill#: <br /> 6. Sample Labels: t 1 Absent <br /> 7, Sample Ws: is 1 Not Listed <br /> o -of-Custod <br /> 8. Sample Condition: ct/Broken*/ <br /> Leaking <br /> 9. Does information on <br /> custody reports,traffic <br /> reports and sample <br /> labels agree? /No* <br /> >: IQ. Sample received within 1 <br /> hold time: es I No* ' <br /> 11, Proper Preservatives <br /> used: L91s I No* <br /> 12. Temp Rec_ at Lab: s <br /> (Acceptance range for samples <br /> re iii r4no thermal res,:4}I-2°C /No* <br /> r <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revision 2.1 (1 1110100) Page of <br />