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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: DATE Received at Lab: (Drinking water)for <br /> REC.BY(PRINT) TIME Received at Lab: /00-0 regulatory purposes: YES/N0 <br /> WORKORDER: LOG IN DATE: n (Wastewater)for <br /> regulatory purposes: YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE ff # CLIENT ED DESCRIPTION MATRIX SAMPLED CONDITION(ETC. <br /> 1, Custody Seal(s) 0 Wzo 0!�v <br /> 2. Chain-of-Custo Absent- 2-- <br /> 3. Traffic Reports or <br /> 7 <br /> Packing List: p5m! ALb2se <br /> 4. Aitbill: Sticker <br /> reser Absent <br /> 5. Airbill <br /> G. Sample Labels: Absent <br /> 7. Sample IDs: riste <br /> j)/Not Listed <br /> op�C <br /> kair-of-Custody <br /> S. Sample Condition: 0:ntae0/Broken* <br /> LeakinE* <br /> 9. Does information on <br /> Custody reports,traffic <br /> reports and sample <br /> ----------- <br /> i labels Rgree? ,"Ye No* <br /> 10. Sample received within <br /> hold time: No" <br /> 11. Proper Preservatives <br /> used: No* <br /> MP Rec,at Lab: <br /> (Acceptance range for samples <br /> requiring thermal 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(11106/00) Page of <br />