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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIEN T NAMEpav�� DATE Received at Lab g I_j (Drinking water)for <br /> REC BY (PRINT) TIME Received at Lab regulatory purposes YESINO <br /> M WOItKORDER 3;?V--j;�to LOG IN DATE 6 (Wastewater)for <br /> t regulatory purposes YES/NO <br /> CIRCLE I HE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC) <br /> 1 Custody Seal(s) Present/ t a <br /> ro <br /> Intact/Bn* <br /> 2 Chain-of-Custody rese t/Absent* <br /> 3 Traffic Reports or <br /> Packing List Present Abse <br /> 4 Airbill Airbill/Sticker <br /> Present/ bsen <br /> 5 Airbill# <br /> 6 Sam le Labels t/Absent <br /> 7 Sample 117sList J Not Listed � <br /> on hain-of Custod <br /> 8 Sample Condition Qamg <br /> Broken*1 <br /> 9 Does information on <br /> custody reports,traffic <br /> reports and sample <br /> labels agree? /No* <br /> 10 Sample received within <br /> liold tune No* <br /> I I Proper Preservatives <br /> used e No* <br /> 12 Temp Rec at Lab <br /> (Acceptance range for samples <br /> rm <br /> �irtu.&thermal pres 4+/-2°C Yes/No* <br /> Q 'R <br /> *If Circled, contact Project Manager and attach record of resolution <br /> Sample Receipt Log <br /> Revision 2 1 (11110100) <br /> Replaces Revision 2(11106100) Page Of <br />