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s • • <br /> SEUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> y vM.♦ J..v s. -. r r+.v� ri r <br /> CLIENT NAME, DATE Received at Uh, ^ � �� `(Drinking w,atet)fiij <br /> RFC BY(PIUNI') ('f� „ 7'11111✓Received at Lab giep regulitory purposes- Y1S <br /> WORI{ORDER. c � LOG IN <br /> 1 [,� (WASLClYAtCC) for <br /> regulatory purpos" V 0 <br /> CTRCLE THE APPROPRIATE RESPONSE 7.Al2 5A1t9YEE 1}Al L+ <br /> SA11U'LE 4 # CLEM Ill WSC:RIPTtON MATRIX SAMPI; D CONDI IION(LPYC) <br /> 1 Custody Seal(s) Present(Alas C <br /> intact 113rokenO ( - <br /> 7 Chain of()astody rcz A f Absent* — <br /> 3- Traffic Reports or - <br /> , <br /> Packing Lim Present CAVsci I) <br /> 4 Airbill AirbiII t Shaker <br /> Freseut I <br /> 5 Airbili 11- <br /> 6 Sample f,abcls tf Absent <br /> i 7 Sample IDss d/Not Listed <br /> of 'Ihahih-of-Custod� ' <br /> S. Sample Cottdition An liroketl'f <br /> �ed iug� <br /> 1 9 Dnts hnfiumahQn on <br /> i <br /> custerlyreports,imffic <br /> reprutp,and sample <br /> labels x ea? cs No* ` <br /> 10. NaTnplc rucived witb1R <br /> ]hold tune No* E <br /> I I Proper Pra$cwati',es <br /> used No <br /> 12 Trap Ree at Jab <br /> (Acceptance range,For samples <br /> re hrrAhg tlhetrhtal res A+1-2°C) Yes/No's <br /> msioeeena+.Kox,..tcc,.c:.a�e r µs. cv.4s. <br /> osxwca � <br /> M' <br /> "if C1.i'ded, contact Project llauager and attach record of 1esolutian. <br /> Sample ptaraept Log <br /> Revtslon 2 1(11/10=) <br /> Replacas Revision 2(1 IMM) PF�gG of <br /> t;!(ectwo 11112140 <br />