Laserfiche WebLink
SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: DATE Received at Lab: 1 2-Z, (Drinking water)for <br /> w REC.BY(PRINT) Talk Received at Lab: re intopurpose-s: <br /> gu ry Y. <br /> ' 1VURKORDER: r!i LOG IN DATE: ` (Wastewater)for <br /> 'r <br /> regulatory purposes: YES/N <br /> CIRCLE THE APPROPRIATE RESPONSE LAB Dash CONTAINER SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION pH MATRIX SAMPLED CONDITION(ETC.) <br /> W. <br /> 1. Custody Seal(s) Present-lf) is <br /> t Int I Broken* <br /> 2. Chain-of-Custody, rese /Absent* <br /> 3. Airbill: 'ill <br /> It/Absent <br /> �.S <br /> 1 <br /> 4. Airb ill#: .� (5-C��:J`' L'4=ti k,12- <br /> 5. <br /> 25. Sam le Labels: res I/Absent <br /> G. Sample 113s: is /Not Listed <br /> 1 on Chain-of-Custod O L <br /> 7. Sainple Condition: rctict/Broken*/ <br /> Leaking* <br /> • 8. Does information on custody reports, <br /> 1, traffic reports,and sample <br /> label§ - <br /> r 9. Sample received within <br /> bold time:-. , "/No* -- <br /> 10. Proper Preservatives E <br /> r used: /No* <br /> r. • <br /> 11. Teta erature Blank Received? Yes/ <br /> 12. Ternp Rec.at Lab: - degrees C <br /> (Acceptance range for samples _ <br /> re uiring thermal res.:4+1-2°C) 6s'/Noy` <br /> < 13. Samples collected!!lore <br /> than 4 da s a v7 <br /> Sample Receipt Log <br /> *If »�c a contact Project Mana pr and attach record of resolution. <br /> —' ' <br /> Revision 2.2(8/30104) <br /> Replaces Revision 2.1 (i Ill 0100) page of <br /> EEloolive 9W04 FIGURE 6b <br />