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0 <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> .. ..... ... ...... <br /> CLIENT NAME: DATE Received at Lab: Mill I <br /> (Drinking water)for <br /> HEC. BY (PIUNT) TIME Received at Lab. regulatory purposes: YES/NO <br /> WORKORDER: LOG IN DATE: (Wastewater)for <br /> regulatory purposes: YESfNO <br /> CIRCLE TIM APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# k CLIENT ID DESCRWTJON MATRIX SA31PLED CONDITION(ETC.) <br /> P <br /> 1. Custody Seal(s) PresentrAbseilif�) <br /> Intact I BroTee Cqj <br /> 2, Cimin-of-CM10d Prose 1 Absent* <br /> 3. Fraflic Reports or <br /> Packing List: Present bset <br /> 4, Airbill: Airbill Sgi;kpr <br /> PresefleAbse <br /> 5. Airbill <br /> G. Sample Labels: af�e /Absent <br /> 7. Sample IDs: (aLj@>Not Listed <br /> on Chain-of-Custody <br /> 8. Sample Condition,. �/Broken- <br /> Leaking! <br /> 9. Does information on <br /> custody MPOIIS, traffic <br /> k <br /> repoils and sample <br /> (35�f No- <br /> labefs ng=? <br /> 10. Sanzpie received within <br /> 1101d 6111C. o <br /> 11, Proper Preservatives <br /> 7 <br /> used: 1 NO <br /> 12. Teinp Rec. a[ Lab: <br /> (Acceptance range for samples <br /> -equiring thermatpres,.4+/-21C) Yes No* <br /> *If Circled, contact P;I-aJect Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revision 2.1 (11/1 OfW) Page of <br />