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{ SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: --� DATE Received at Lab. ^ �i (Drinking water)for <br /> REC BY(PRINT) TIME Received at Lab: regulatory purposes, YESINO <br /> WORKORDER + J LOG IN DATE: - (Wastewater)for <br /> regulatory purposes: YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC) <br /> x I Custody Seal(s) res t I Absent — V� <br /> tt ac Broken* =f <br /> 2 Chain-of-Custody esen I Absent* <br /> 3 Traffic Reports or <br /> Packing List Present/ <br /> 3 4 Airbili Airbtll I St r <br /> Present/ bsett E <br /> 5 Airbill # �f <br /> G Sample Labels /Absent <br /> 7 Sample IDs rst I Not Listed <br /> on Cham-of-Custody <br /> R Sample Condition ntac /Brokett*I <br /> tis n * <br /> 9 Does inforniatton on <br /> custody reports, traffic i <br /> reports and sample { <br /> labels a Trees e I No* <br /> 10 Sample receiredwitlun <br /> hold time <br /> 11 Proper Preservatives s i <br /> usedY /No* <br /> 12 Temp Rec at Lab <br /> (Acceptance range for samples TD <br /> '1!Sqa1r111.&therinat Eres 4+1-2°C) ize /No <br /> a w r <br /> *If Circled, contact ProM <br /> ject a a er a ord of resolution. <br /> Sample Receipt Log <br /> Revision 21 (1111 i 1GO) <br /> RentarP¢Ravlainn 9!1 1 ff7r!(1f11 Page of <br />