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• i � <br /> SEQUOU,ANALYTICAL SAMPLE IZECRIPI`LOCO <br /> � - CY.IENT I+IAMF. � HATE ItecerFetl at Lab., t � Y (1}rintrlug water)for <br /> RFC.BY(PR1N'!) TMIFF deceived nt Lab l t regulatae) purposesIMQUIA Ica 'fl <br /> WORK010Wlt. b U LOG IN DA't'P, Cam (Wastewater)far <br /> regntatory purposes: Y C3 <br /> CIRCLETIIEAPPROPRIA`t']N:lt1�.SPONSF LABSAMYt1L+ DATE <br /> SAMPLUR B CLEE,N!W DESCTtIPTION I MATRIKI SAhIPIX) CONPITION(ETC.) <br /> 1 (Lsloc4y Scal(s) Present Abseil X17 '3 ( 10 t <br /> Intftct!lir lr+err' - lJl'1�t-3'—t <br /> 2 tbam-of-C'ut4d C8e t I Absent' <br /> 3 TrwffmReportsor V <br /> Packing t est Presen <br /> 4 Aubill A�rbill tcs� <br /> Present <br /> 5 Ai:trill#1 t <br /> G S le I.ahels es t!Absent <br /> 7 Sample 3Ds 1 Not l_islcd <br /> on i:h8.rn-oir G1,sta! <br /> 8 Sarirplc C andetion: t-a'k limkcn�/ <br /> 9. Does mfbnwtton on <br /> custody reports, trafrio <br /> reports and sample <br /> labels a c7 ess' I�fo� <br /> 14. Sarnplo recelycd►vitllul <br /> hold time No* <br /> i l- PmperPresCrvativa9 I <br /> �tcd_ es No* <br /> 12 Temp Rec at Lab, <br /> (Acceptance range for samples — <br /> reZu-w&thermal pres.-4+1-7 'Yes 1 NO* <br /> VMw_ IF <br /> *If Circled,eonfinct Project Mattager:ind of ach record of rccnttition. <br /> Sample Receipt Log <br /> Revision 2 1 (1111UM) <br /> Page of <br /> Replaces Hevlslorl 2(1 110M) <br /> EFlecinso 11112104 <br />