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i • • <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME DATE Receivi.d at Lab (Drinking water)for <br /> RLC BY(PRINT) J2DJQn/\A(`a TIME Received at Lab f36 v regulatory purposes YESIn <br /> WORK ORDE T^ [j LOG IN DATE 3(o2(p ( (Wastewater)for <br /> regulatory purposes YE <br /> CIRCLE THE APPROPRIA71 E RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDI'T'ION()E;I'C) <br /> I Custody Seal(s) Present/ bsen YT1 l v If Cj 0 <br /> i <br /> Intact/13ro en* -- <br /> 2 Chaim-of-Custod rese /Absent* <br /> 3 Traffic Reports or <br /> i Packet List Present sen I <br /> 4 Airbill Airbill A is er <br /> Present/ b e <br /> S Airbill# <br /> 6 Sample Labelst 1 Absent <br /> 7 Sample IDs VlNot Listed <br /> on Cham-of-Custody <br /> I 8 Sample Condition itac Broken*/ <br /> � m <br /> 9 Does wformation on <br /> I <br /> custody reports,traffic <br /> reports and sample <br /> labels agree? e /No* <br /> 1 to Sample received within <br /> f hold time Yes No* <br /> 11 Proper Preservatives t <br /> used few No* <br /> 12 Temp Rec at Lab <br /> I <br /> (Acceptance range for samples <br /> re ulrwg thermal Eres 4+1-2°C) Yes/No* <br /> 7 Y <br /> *If Circled, contact Project Manager and attach record of i esolution <br /> I <br /> Sample Receipt Log <br /> Revision 2 1 (11/10/00) <br /> Replaces Revision 2(11/06/00) Page of <br /> Effective 11/12/00 <br />