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Cr <br /> SEgUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: IT 6FIE <br /> DATE Received at Lab: Drinking water for <br /> RE C.BY (PRINT) TIME Received at Lab: regulatory purposes: YE il+�E <br /> WORKORDER: L f LOG IN DATE: Wastewater for <br /> regulatory purposes: YES 0 : <br /> CIRCLE THE APPROPRIATE RESPONSE LAB CONTAINER SAMPLE DATE REMARKS: <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(r-,TC. <br /> I1. CustodySeals Presen risen I VV J ' -' M VIA Wo <br /> Intact/Broken* , <br /> 2. Cham-of Custod Pfeisi n�6 Absent* <br /> 3. Traffic Reports or <br /> Packinghist: Presen LAbsen�i <br /> �4, Airbill: Airbill/Sticker <br /> Present I -bse <br /> 5. Airbill 0: <br /> 6. Sam le Labels: Present-/ bsent <br /> 7. Sample 1Ds: -is-feY Not Listed <br /> on Chain-of-Custod <br /> 8, Sample Condition: , nr ta-ct Broken.*/ <br /> Leaking* <br /> 9. Does information on <br /> custody reports,traffic <br /> reports and sample }}_ <br /> labels a pee? e l No* <br /> 10. Sample received within <br /> hold time: ° /Ya;/No* <br /> 11. Proper Preservatives <br /> used: :!Ye I No* <br /> 12. Temp Rec.at Lab: <br /> Is temp 4+/-2°C? Yes/No** � <br /> (Acceptance range for samples req►firing thermal Pres.) <br /> "Exception(if any):Metals/DFF on ice?/DFF no ice? <br /> or Problem COC <br /> *If Circled contact Project Mana er and attach record of resolution. <br /> Sample Receipt Log J <br /> Revision 2.3(52/ UM) Page of <br /> Replaces Revision 2.1(04111102) <br /> ective 12/24/02 <br />