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• 0 • <br /> SEQUOIA ANALY'T'ICAL SAMPLE RECEIPT LOG <br /> 3 <br /> CLIEN T NAME- '� <br /> DATE Received at Lab: (Drinking water)for <br /> REC.BY(PRINT) TIME Received at Lab: regulatory purposes: YES/NO <br /> WORKORDER: 0B ti LOG IN DATE: (Wastewater)for <br /> regulatory purposes- YES/NO t <br /> i <br /> CIRCLE THE APPROPRIATE RESPONSE LAB Dash CONTAINER SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION pH MATRIX SAMPLED CONDITION(ETC.) t <br /> 107 5 <br /> 1 Custody Seal(s) re t 1 Absent <br /> (lat/Broken* <br /> 2 Chain-of-Custody r se t/Absent* 4 <br /> 3 Airbil! Alrbtll/Sacker ° <br /> k <br /> Present 1 Adle <br /> 4 Airbill# <br /> 5 Sample Labels /Absent <br /> G Sample IDs sem. /Not Listed <br /> on Chain-of-Custody <br /> 7 Sample Condition a t/Broken*/ <br /> Leaking* <br /> 8 Does into!enation on custody reports, <br /> traffic reports,and sample 1 <br /> labels a ice? Q/No* <br /> 9 Sample ref caved within <br /> hold time X&Y No* <br /> 10 Proper Preservatives <br /> used ese /No* i <br /> 11 Tetn erature Blank Received' <Ws/No's <br /> 12 'i emp Ree at Lab degrm c t <br /> (Acceptance range for samples <br /> re uiiui (hernia!pres 4+/-2°C) A/No's <br /> 13 Samples collected more <br /> Haan 4 days a 0 Yes*1 <br /> *If Circled,contact Project Manager and attach record of reso u on. <br /> Sample Recerpl Log <br /> Revision 2 2(8130104) page of <br /> Replaces Revision 2 1 (11110100) FIGURE 6b <br /> Cllerlive 911104 <br />