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0 0 <br /> SEQUOIA ANALYTICAL SAMPLE RE,CEIPnnTLOG <br /> CLIENT'NAME- DATE Received at Lub 9,0 G (Drinldng water)fot <br /> l REC BY(PRINT) ofTIME Received at Lab: a �9-C/ regulatory purposes: YEls <br /> j W ORKOI3DER• 7(��— LOG IN DATE- d��;' <br /> i �,�,..,.._. � T j ••,d � (Wastewater)for <br /> regulatory purposes- X,1a'„S <br /> t. <br /> 1 CIRCLE TIIE APPROPRIATE RESPONSE LAIR Dash CONTAINER SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION phi MATRIX SAMPLED CONDITION(ETC.) i <br /> �C <br /> I Custody Seat(s) resent/ bsent <br /> Inta f Broken* + <br /> I 2 Clltulrof-Castod Pxesen /Absent*, <br /> 1 3 Arrbrll AuubdI/Stic <br /> I —Present/Ase <br /> 4 ArxblII# <br /> 5 Som le Labels /Absent <br /> t ti Sample IDs tsted Not Listed <br /> t on Ctrain-of-Custod <br /> 7 Sample Condition X 1 Broken*1 <br /> ' L un * <br /> 8 Does lufortnatuon on custody reports, <br /> I. <br /> j traffic reports,and sample <br /> I <br /> labels a eel rYlesNo <br /> 9 Sample r4celved within <br /> a bold tune /No* <br /> 10 Proper Pfeservatuves <br /> used No* <br /> I l Tenr ern ure Blank Received? es 1 No* <br /> } 12 'Temp Rec at Lair egceea e <br /> (Acceptance range for samples <br /> re uiruu thertulal pres 4+1-2°C) s No* <br /> 13 Samples collected more <br /> Chau 4 days ago? Yes* No <br /> Sample Receipt Log *If Circlod, contact Project Manager and attach reedlyd bf rn <br /> esolutio . <br /> Revislan 2 2(0130104) <br /> Replaces Revision 2 1 (11/10/0o) Page Of <br /> FllarllunQ111nA rllnlprim r� "'-- <br />