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• i i <br /> SEQUOIA ANALYTICAL SAl1TPLF, RE'C:N1TPT LOG <br /> CLIENT NAME, DATE Receiver]at fab, � ti� '(Drinking water)fin , <br /> RFC 13Y(PRINT) 7'1141),ltcecitcd at 1.g1} - qo regulatory purposes: Y1Sl <br /> WORKORDER. S-22-42 LOG IN1 AIE. �.,6P —_.. (Wastmatcr) for <br /> regulatory purpos". YF f3 <br /> CTRCLE THE APPROPRIATE RESPONSE X.All SAMPLE 1)A1L <br /> SANUILE# # CLTENI Ila TfFWRiPTIDN L41ATIZTX SAMPLED CON0111ON(LTC) <br /> 1 �'ustady Seals} €'resent Abs f — IPA <br /> Intact I Brokcw* (� -- <br /> 2 Chlin ofCUSLOdy res rElAbscnt* <br /> 3. Traffic Rcports or - <br /> + Packing LisE PresentA set 0 <br /> 9 Airbill A rbill l Shc%cr1p <br /> � Ytesettt I � <br /> S Airbili <br /> G Sample IAMB I 1 Absent <br /> 7 Sample IUs s d f Nal Listed <br /> of 'hain-of-Custod ' <br /> S. Sample Condition Intac Broken,1 <br /> ,ca iugi <br /> 9 On"information cn <br /> Cwtlady reports,traffic <br /> reput.3 anti sample <br /> labels agree? es Nfl* 1 <br /> 10 Sample receiver]within <br /> Bold tutee Nom <br /> I <br /> i I Prnl,Cr Preservaly es <br /> umd j p+ <br /> 12 "Temp Rec at Lab <br /> , <br /> (acceptance mrige for sample& <br /> re ttrli ther�uuai pres d}1-2°C) Yes I Ho* <br /> I'll ILt. <br /> 69"ONJi6fAC((CACi[,%w\l[t�Gipr. r l+V. V.t+.y�1 s <br /> 409hM[0. <br /> 7f Ctrcicd, confttct Project M.-mager and attach record of iesolntion. <br /> Saropla KotelptLog <br /> Revtsbn 2 1(1 M0*0) <br /> Replaces Revision 2(11f WM) Page of <br /> �i<eurwa 1#l�?1Q0 <br />