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_ 10111ir _ _ M _ M _ 9M _ _ _ _ _ _ _ <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> ' ii <br /> CLIENT NAME: .�G/`(, DATE Receaved at Lab: (DAnlciDg water)for <br /> RREC.BY(PRIM') G TIME Received at Lab: — /lot a regulatory purposes: "��J <br /> WDRKORUER: —1 LOG IN DATE: (Wastewater)for <br /> regulatory purposes: <br /> CIRCLE THE APPROPRIATE RESPONSE LAB Dash CONTAINER SAMPLE DATE <br /> SAMPLE# # CLIENT ID DPSCR2T10N pH MATRIX SAMPLED CONDMON(ETC.) <br /> I. Custody Seal(s) Present A!s <br /> Intact/Broen* <br /> 2 (dam-of-Cwtod fese t/Absent* <br /> 4 Aubill Aubill/Sticker <br /> Present/ <br /> 5 AubtTl# <br /> G Sample Labels nese /Absent <br /> 7 Sample IDsLute /Not Listed <br /> on Cham-of-Custod <br /> 8 Sample Conationact Broken*/ <br /> 4 Does information on custody reports, <br /> traffic reports,and sample <br /> labels agree? o* <br /> ' 10 Sample received withm <br /> hold tone 'e /No* <br /> 11 Proper Preservatives <br /> used ! <br /> 12 Temperature Blank Received? Yes/ <br /> ' 13 Temp Rec. at Lab C <br /> (Acceptance range for samples <br /> re nlnn thermal res•�+!-21Ye 1 No* <br /> 14 Samples collected more <br /> than 4 days ago? y <br /> *If Circled,contact pro ect Manager and attach reeord of resolution. <br /> Sample Receipt Log <br /> Revision 2.2(8/30/04) <br /> Replaces Revision 2 1(t 1110106) <br /> Etteclive 911164 page of <br />