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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: DATE Received at Lab: (Drinking water)for E <br /> RE C. BY(PRINT) TIME Received at Lala: 3d regulatory purposes: YES <br /> WORIORDER: LOG IN DATE: -�, (Wastewater)for <br /> regulatory purposes: YE N <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> r SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDI`T'ION(ETC.)' <br /> 1. Custody Seal(s) Present sen 3 --.1 777 <br /> Inta / <br /> 2. Chain-of-Custody, res t/Absent* <br /> 3. Traffic Reports or —t <br /> Packin List: Present Ase 5 <br /> 1 4. Airbill: AirbiIl/Stacker b <br /> Prese�it/ b <br /> S. Airbill#: —31 <br /> T <br /> 6. Sample Labels: re t/Absent 1 <br /> 7. Sample IDs: s /Not Listed <br /> on Chain-of-Custody <br /> 8. Sample Condition: /Broken*/ <br /> q&akmg* <br /> 9. Does information on <br /> custody reports, traffic, <br /> reports and sample <br /> labels agree? • e No* <br /> 10. Sample received withut <br /> hold time: es No* <br /> 11. Proper Preservatives <br /> J. used: e /No* <br /> 12. Temp Rec. at).ab: <br /> (Acceptance range for samples <br /> re uiru� thermal res.:4+/-2°C Yes/No* <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revision 2.1 (11/10100) <br /> Replaces Revision 2(11/06/00) Page of <br /> EHeclive 11/12/00 <br />