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i <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG } <br /> I CLIENT NAME DATE REC'D AT LAB l 21 to For Regulatory Purposes? <br /> REC BY(PRINT) E F Et - TIME RECD AT LAB t3 o DRINKING WATER YES I 1� <br /> WORKORDER 1/'1 P 1 '- DATE LOGGED IN ` q,;,, e,4 WASTE WATER YES N4 <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV SAMPLE DATE REMARKS• <br /> SAMPLE# # <br /> CLIENT Ip DESCRIPTION ATIVE AH MATRIX SAMPLED CONDITION(ETC) <br /> 1 Custody Seal(s) ht Absent <br /> tail Broken* <br /> 2 Chain-of-Custody Srint/Absent' <br /> 3 Traffic Reports or <br /> f <br /> Packing List Present/Es t <br /> 4 Airbill irbt /Sticker <br /> s <br /> Present/Absent <br /> 5 A+rbili# Cs(,2u{r Dl oo tap'7g5S2 t,i74 <br /> 6 Sample Labels rase t/Absent <br /> 7 Sample 1Ds `ste /Not Listed <br /> j on hain-of-Custod <br /> 8 Sample Condition pita t/Broken*/ <br /> Leakin * <br /> 9. Does information on chairs-of-custody, <br /> I traffic reports and sample labels <br /> a <br /> agree? ess No* r <br /> s <br /> 10 Sample received within <br /> hold time? Y s No <br /> 11 Adequate sample volume R <br /> received? /No* <br /> 12 Proper preservatives used? Ybsy No* <br /> 13 Trip lank I lijiiip Blank Receive <br /> circle which,It ) YL)/No' <br /> 14 Read Temp 31 L ' <br /> Corrected Temp 3 il4 <br /> Is corrected temp 4+/•2°C? lf&I No** <br /> I(Acceptance range for samples requiring thermal pros i II <br /> `-"Exception(if any) METALS 1 DFF O lC <br /> or Problem GOC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION, JJ <br /> SRL Revision 7 Page l of f <br /> Replaces Rev 5(07/13/04) <br />