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• • <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME <br /> tARS , „ � DATE REC-D AT LA[3, ZI•S For Regulatory Purposes? <br /> RFC. BY(PRINT) _&oil m5„ -„ TIME RECD AT LAB: '. 1 D DRINKING WATER YESIQ'0 <br /> WORKORDER• - - - kZj('t2$(-,; _ DATE LOGGED IN. - -L>-r, WASTE WATER YESOgP <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CLIENT ID CONTAINER PRESERV pH SAMPLE DATE REMARKS <br /> SAMPLE# # DESCRIPTION ATIVE MATRIX SAMPLED CONDITION(ETC) <br /> I Custody Seal(s) rase t. b1 -G LLQ— 3�-V f., -4 R <br /> Inta Broken* bt. �- <br /> 2 Chain-of-Custody_ rase /Absent' -- <br /> 3. Traffic Reports or <br /> Packing List Present/ bse t - <br /> 4 Alrbili irbke <br /> il Sticr <br /> e t/Absent dy —7 <br /> S Airbiu# p1C)0kC0616t(4C66 a B11t11107 00 Z-U00% ' <br /> 6 Sample Labels 92RAbsent <br /> 7 Sample IDsLista of Lls <br /> on hain-of-Cu <br /> B Sample Condition nta I Broken'I <br /> Leaking* <br /> 9, Does information on chain-of-custody, <br /> traffic reports and sample labs s <br /> agree? Yes No* <br /> 10 Sample received within <br /> hold time? CosNo* <br /> 11 Adequate sample volume <br /> received? /No* <br /> 12 Proper preservatives used? /No* <br /> 13<np lank/Tamp Blank Rec ve <br /> circle which,ii s e /No' <br /> 14 Read Temp 3,Z <br /> Corrected Temp , <br /> Is corrected temp 4+/-2°C? es No** <br /> (Acceptance range for samples regainng thermal pros) <br /> **Exception (if any) METALS / DFF ON ICE <br /> or Problem COC <br /> *IF CIRCLED, CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION <br /> SRL Fievlslon 7 <br /> Replaces Rev 5 f07/13/04) Page i of t� <br /> errecirveaVIWS <br />