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SEQUOTA ANALYTICAL SAMPLE RECEIPT LUG <br /> CLIENT NAME: R�Am— DATjZ ttltelved a#Lab-. �/-,)40 -1Drinking water for <br /> RBC.BY(PRINT) TIME Reedved at Lab: RX5 regulatory lmnmm <br /> WORKORDER: b LOG IN DATE: t' Waatews(er for <br /> regulatory purposes: Y f A( <br /> CIKCLE TIIE APPROPRIATE RUPONSE LAB CONTAINER SAWLE DATE RFMARKS: <br /> SAMPLE# 9 CURNT ID DESCRIPTION MAT= SAMPLED COMMON .TC. <br /> I. Custody seat(o) PresQnt Ab <br /> IatactlH * - <br /> 2. Chain-of-Cuslad t I Abseut* <br /> 3 TraliicReparts or - <br /> Farlin List: Present Abse <br /> 4. Alibill Abbill 1 Sty <br /> Pmt! <br /> S. Airbill#. <br /> G Bain le[.abels: IAbsent <br /> 7 Sample]Ds: � l Not Usted <br /> ont h�itt�f�st ', <br /> 8, sample Cvndma. lac 1 Broken*1 - <br /> 'n _ <br /> 9. Does infomiaUan on ' <br /> custody reports,traffic - - <br /> M vrts and sampeo <br /> Ws a roc? Q/NO* - <br /> 10 Sample received within <br /> hold time - <br /> LPOP*,W <br /> � vees No'sic.atLab:4+1-2°C7 - Yes 1(�far mnptes togm e&}(tf any):Metais l FF on toc7 f FF no 1087(cm COC <br /> ARK <br /> *If Circled contact KokEl Mansser and attach record of resolution, <br /> R�casiarl�.I(04 IMA Pago <br />