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0 i <br /> SIs( 001A ANALYTICALSAMPLE.. ]tEN'lt HYF LOG <br /> CJ.TFN'T NAME: <br /> DATE Received sit Lab: �� b (mmkung wvatcr) for <br /> ITEC.BY(PILIN L) tMIE Received at Enh }�L,{, � regulatory purposca. Xk.tt*i0 <br /> wpRKOlt13]?R: 1,0C;IN DATE: t`�I�ItT� (Wastewatet)for <br /> regu[atory purposes <br /> CIHCLRTHE AP.PIZOPRTATE1;l MONSR l.h11; SAMPLE DATE <br /> SAMPLE# # CLIIENI ID DIES[RIP LION KNII? X SA141=1'L 1) CONDITION(E i C? <br /> 5 <br /> 1 Custody.cal() I'reaertt Absent <br /> Intact I Dro <br /> *J <br /> 2 Chaut-of-aistodresci AbselO <br /> 3 Raffir,kepDrts orell <br /> r <br /> Psckin List Present bse <br /> A Airbill Airblll I Sticker <br /> Presetrtt b� ', <br /> S Airbtll# <br /> b Sipple Labels r n1 f Absent <br /> 7 SamplelAs 1 Not Lusted <br /> of �atn-�f-i~u9tocl <br /> 8 sample condilron tact Hrokca}I <br /> 9 Dots rafomtation on <br /> custody reporls,katlic <br /> reports and susiuple <br /> labels a&m <br /> Vl >!0 Saniplc rcemcd withyn <br /> [cold tame es Noy <br /> f <br /> 11 Proper Preservatives <br /> used A/No* <br /> 12 Tsmp Rec at Lab <br /> (Acceptance range for samples <br /> Ure uit�n therm>}I res W-M) Yes Mo* <br /> fFu <br /> *If Circled,eonfarf Ptolcct Manager and attach record or tesolubon <br /> Sample Receipt Log <br /> Romlon 21{11!10100} Frage of <br /> keplaces Revislon 2(11109100) <br /> Effactrva 11112100 <br />