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SEQUOIA ANALYTICAL SAMPUE ItL1 ChIPT LOG <br /> .W.4Y.'Y.•J.Y.NUJ-uw���w_s'_r:��._.i .)>.s M �s.fai..'• �N <br /> Cr!"1INT NAMU: DATE Received at Ub: Iti` R (Drinking,rater)for <br /> (I-1001) � '1'111+1]:IteceiVed at 1.94. regntatory Purposes: 1t1.Sf <br /> W01RICORDER-. T ��`'` ) LOC 1N DATE: (SWastmafer) for <br /> reguratory purposes: 3 <br /> CIRC:UK TH&APP11 PATATE itMFONSE LAH SAmpLlr. T)ATF, <br /> SAA'IPLE# # CLrRNT l l) )AMR)IMON NItl IVIX SAMPLED C ONt) IJON <br /> 1.03stody SealA s <br /> Seal(s) Prescii en 1�...}YY-J. — V28 LIJ <br /> r <br /> Jntact t wa Eel, <br /> -99 <br /> 1 2. Chain-of-Qistod ,rseut Absent* <br /> 3. Tratl l C RepurL%Oir r <br /> Parkin List: Present eu <br /> d. Airbill; Airbillf er <br /> Prescal .A-bs n W' � <br /> S.Aid,itt N-- <br /> 6. <br /> _G. Sam le JAbels: Pr t f AbseaT _ 4 <br /> 7. Sample 103: L step mat Listed 1 `-L <br /> on 'pain-oF Gtiistvcly _ € <br /> S. Sample coadilien: =WaBroken*!rIL <br /> 9. Does information on <br /> custody repods,traffic <br /> ' reports and sample <br /> labels agree? es No* <br /> 10. Satnplereceived within <br /> hold time: Na3 <br /> 11. ?=per Pirzorvatives }} <br /> used: Nay y <br /> 12.Temp Ree.;it Lab: <br /> (Acccplancz range for samples <br /> re u <br /> kiing Iherinal res.4-1--f-2'G Yes 1 NO <br /> kmw K <br /> *If Circled, eoninct Project Mminger and Affach record of resolution. <br /> SampTe ReoeTpl Log <br /> R svisTon 2.1(t 1110!00) <br /> Rcplacw RwTsfon x(11r06fD0) Page of <br /> E}(acl,vd ltJt2r8q <br />