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0 <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME ,' j ,g ►�I'r�naztr. jjG DATE RECD AT LAS- - For Regulatory Purposes? <br /> 1 REC. BY(PRINT) A < Cr- TIME RECD AT LAB- DRINKING WATER YES/ <br /> WORKORDER AIT(-t I:0z) IRATE LOGGED IN 3 '� ! 0 L WASTE WATER YES NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CLIENT ID CONTAINER PRESERV SAMPW DATE REMARKS: <br /> SAMPLE# # DESCRIPTION ATIVE PH MATRIX SAMPLED CONDITION(ETC) <br /> 1 Custody Seal(s) Present 1 se 01 A,- F b 1/0" 14-tt r •� <br /> Intact/Broken* bz F,--C <br /> 2 Chain-of-Custod nese Absent* 03 W <br /> 3 Traffic Reports or 04 AAUU <br /> Packing List Present 1 sen <br /> 4 Airbill Airbill/ Oi� <br /> ese Absent t� <br /> 5 Airbill# U a(0 D r se [)� <br /> 6 Sample Labels, /Absent - <br /> 7 Sample IDs 1 Not Listed '0 <br /> on Chain-of-Custody <br /> a Sample Condition EtBroken*1 <br /> Leakin * <br /> 9. Does information on chain-of-custody, _ <br /> traffic reports and sample labels <br /> agree? <br /> 10 Sample received within <br /> hold time? es No* <br /> 11_ Adequate sample volume <br /> received? 01 No* <br /> 12 Proper presetvatives used? /No* <br /> 13 Trip Blank/Temp Blank Received? <br /> circle which,If es Yes 1 Qo <br /> 14 Read Temp, 41 u <br /> Corrected Temp 4 . o °"C/ <br /> Is corrected temp 4+1-2°C? Yes No** <br /> (Acceptance range for samples requiring the 1 pres) <br /> *`Exception (if any) METALS / DFF ON ICE <br /> or Problem COC <br /> *IP CIRCLED, CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION. <br /> SRI.Revision 7 <br /> Replaces Rev 5(07113/04) Page of <br />