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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME � DATE Received at Lab: - Z -'-2 (Drinkrng wafer)for <br /> REC. BY(PRINT) TIME Received at Lab: f regulatory purliosea: YESINO <br /> WORKORDER- LOG IN DATE: — $-() (Wastewater)for <br /> regulatory purposes: YES/NO <br /> CIRCLE THE APPROPRIATE RESPONU i LAB SAMPLE DATE <br /> Z:��A' 44AMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC) <br /> 1 Custody Seal(s) (Zresen / b t IB n Z <br /> 2 Chani-of-Custodyrese 1 Absent* <br /> I Traffic,Reports or <br /> Pacag ListPresent! bse <br /> 4 .Anbill Airbitl l St e <br /> Present/ <br /> 5 Anbill# { fi <br /> 5 Sample Labels Pr nt/Absent <br /> 7 Sample IDsi tLn-of-Custody <br /> Not Listed <br /> oir <br /> 8 Sample Condition nt I Broken*/ <br /> lung* \ <br /> 9 Does information on <br /> Ostody reports, traffic <br /> reports and sample s <br /> labets agree, /No* <br /> 10 Sample received within <br /> _ bold time Q/No <br /> 11 Proper Preservatives <br /> tised 1 No* <br /> 12 I emp Rec at Lab <br /> (Acceptance range for samples <br /> ierninag thermal gres 4+1-2°C) Y /No* _ <br /> 5. t R S\ .SMS to FWn• n Ci 5eNr 1 0"' <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revision 2 1 (11/10144) Page o1 <br />