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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: DATE Received at Lab: r��(Drinking water)for <br /> REC. BY(PRINT) TIME Received at Lab: t OQgulatory purposes: YES/NO <br /> t <br /> WORKORDER: LOG IN DATE: (Wastewater)for <br /> regulatory purposes: YESfNO <br /> v <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT LD DESCRIPTION MATRIX SAW4ED CONDITION(ETC.) <br /> 1. Custody Seal(s) Ab 1 <br /> I roken* <br /> x <br /> 2. Chain-of-Custody Prese /Absent* <br /> 3. Traffic Reports or <br /> Packing List: Present bsen <br /> 4. Airbill: Airbill l Sticker <br /> Presen Abser t <br /> r <br /> 5. Airbill #: <br /> 6. Sam le Labels: res /Absent <br /> 7, Sample IDs: ft s e Not Listed <br /> on Chain-of-Custody <br /> 8. Sample Condition: Intact Broken*/ <br /> Leakin * <br /> 9. Does information on <br /> custody reports, traffic <br /> reports and sample <br /> labels agree? a No* <br /> 10. Sample received within <br /> hold time: No* <br /> i' 11. Proper Preservatives <br /> used: <br /> No <br /> 12. Temp Rec. at Lab: <br /> (Acceptance range for samples <br /> re uiring thermal 2°C) Yes No <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> sample Receipt Log <br /> Revision 2.1 (11110100) <br /> Replaces Revision 2(11106100) Page Of. T <br />