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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: DATE Received at Lab. (Drinking water)for <br /> REC BY(PRINT) r TIME Received at Lab regulatory purposes; YES/NO <br /> WORKORDER M011 4 LOG IN DATE. (Wastewater)for <br /> regulatory purposes YESINO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC) <br /> I Custody Scal(s) Present Abs <br /> Intact/13ro en* <br /> 2 Chain-of-Custody s t/Absent* 1.4 <br /> 3 Traffic Reports or <br /> Packing List PleKm/ Use <br /> 4 Airbilk 1/Sticker ` <br /> L <br /> t/Absent <br /> 5 Attbtll # 41 OI #36 <br /> 6 Sample Labels re it/Absent <br /> UI <br /> is <br /> 7 Sample IDs d 1 Not Listed <br /> on Chain-of-Custody <br /> n 8 Sample Condition to /Broken*/ <br /> Leakiii * <br /> 9 Does information on <br /> custody icpotLs, traffic <br /> reports and sample <br /> labels agree? Ye /No* <br /> 10 Sample received within <br /> hold tune Y /No* <br /> 11 Proper Preservatives <br /> used Yes No* <br /> 12 Tenip Rec at Lab <br /> (Acceptance range for samples <br /> s <br /> req <br /> Lirwathermal cres 4+/-20C 42M1 No* _ <br /> FWat14 M wa vi um, t M... x J wtyou )a.. <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revision 21 (11!10100) page of <br /> Replaces Revision 2(11/06100) <br />