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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> r .n n••. <br /> CLII.Nf NAME' DATE Rcreived at Lab: � � (Di inking viater) fai <br /> I 12m I3Y(k JuN l) _ TIME Rucived at Lab1` reguIafary purposes: Y TN <br /> WORKOR DETZ; _ LOG LY DATE: (WRsleivater)for <br /> Iegulatorypurposes. YE <br /> CI RCLE T]1H APPROPRIATE RESPONSE LAB SAMPT.R DATE <br /> SAMPLE# # C1.dEN T ID DESCRIPTION [VIATR X SAMi'LED CONDITION(ETC.) , <br /> 4 <br /> I Custody SeaI(s) Presentbscrlt S r <br /> Intact I Broken` J, t4j--Q ---3' <br /> { �.Cltstrt-of Cstod Pry scat Abscnl" <br /> I '� TreA'ic RtcP4rLfi Or <br /> 1 <br /> Packmg Ust presentl6im <br /> I <br /> 4 Arrblll AlrbW19frc e <br /> I <br /> 6 Sam Re Lib0s. Pr e f Absent <br /> 7 Sample IDs tste Not R,Isted <br /> iavi-of-Custody <br /> $ <br /> SampleCondition 11l ct Brokea*I <br /> 9 Does mformation on <br /> custody reports, traffic <br /> reporLt and samplo ~ <br /> labels Nee? Nom W <br /> ` 10 Sample recetsed willun <br /> hold tune. - e No* <br /> L t rcotrcr Pro4ervatives <br /> i used as 7�10� <br /> i <br /> t2 Temp) at Lab <br /> (Acceptance range for satnples <br /> re uinn (hennal r-a 4+1-2°C Yes! To} <br /> *If Circled,celitact Project Man2ger and :attach record ofrcaouhjhon. <br /> Semple Receipt Log <br /> Revtstan 2 I (11110100) y <br /> Re Revision 2(51 MDO) <br /> ElfMW 11112MO <br />