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SEQUOIA ANALYTICAL SAMPLE HECEIPT LUG <br /> CLIENTiNA 19, S ]DATE Received at Lab: 3 t,Cv Dr1nlcinfi wafer fnr <br /> REC.BY(PHIl+l7.7 .�'V1r. a TWE Ruched at Lab: � i� regulatury purposes; YF,S QN <br /> W0RJfL0jW 3R: - LOG IN DATE: � Wastewater for ULL <br /> regulatory purposes. YE. N <br /> CIRCLE THE APPROPRIATE RESPONSE LAB CO)! fA NER SAMPLE DATE REMARKS: <br /> SAMP141Z# # CLIENT ID DFSCIRIPTION MATRIX SA11rIPLRD CONPITJOH(FTCa <br /> 1 Custody Seals) Psent 1 Absent <br /> b118CII Brly ea <br /> 2. Gain-ot=L'��siod Preaea Abset�tx <br /> 3, Tmfflo Reports or <br /> Plicknig List Pe n!! a <br /> 4, Abbill; Airbill I Sucker <br /> Present} se - -- <br /> 5. Airbi11#. <br /> 6 Sam ie Labels Absent <br /> 7 SamplcTDsINot Listed <br /> Ismn-of-Cuaotl <br /> 8 Samrlconditton ► c !I3rokens f <br /> 9. Does Infannatlon on <br /> custody reports,traffic <br /> reports and sample ' <br /> labels am? No" <br /> ' 10 Sampleremved4nihin <br /> ' hold irate No' - <br /> 11 Proper Piaervalivu <br /> used• es Ivo" <br /> 12 Tamp Rec at Lab �P� <br /> Is temp d}I-2'C7 - Yes}Aoy <br /> (Aeseptance tango fur samples regUIZ g thOrmal.ps <br /> *sException(if any):Metals f DFF on 1eo7 Q7 <br /> no i <br /> or problem CDC <br /> BampTA Receipt tog "Ir Circled,contact Project Manager and attach record of resotfrtioln. <br /> Romsbn2.3(12rr3W) _ Page of <br /> Repraces Revision 21(041f 1!112) <br /> Effective 12t24M <br />