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� 1 <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: DATE Received at Lab: <br /> @rin1dog}nater)for <br /> [M5RF,C.BY(PRIiNT) �[ TBM Recelxed at Lab: regulatory purposes- YLr <br /> W ORRORDER <br /> M D'1 q 4 LOG IN DATE: - �z�zt �p f <br /> - (Wastewater)for <br /> regulatory purposes: YE,800 <br /> CIRCLE THE APPROPRIATE RESPONSE LAR Dub CONTAINER SAMPLE I DATE <br /> SAMPLE If # CLIENT ID DESCRIPTIONp MAIMI SA,InPLEV CONDMON(LPTC.) <br /> Z� <br /> I Custody Seal(s) Present/qoeEn�,) <br /> D <br /> 2. chin-of-custody Prese t bsertt* <br /> ON <br /> 3 Aixbill Au t t Sticker ' <br /> Present! en <br /> 4 Airbrll# c <br /> 5. Sample fibels resen /Absent <br /> 6.sample IDs tste /Not Listed. } <br /> on Chain-of-Custody <br /> 7 Sample Condition ntac Token*1 <br /> Leakin * <br /> S. Does information oil custody itports, <br /> a ttaffic repatts,and sample ` <br /> labels a 'e0 y o* <br /> 9. Sample r4ceived within <br /> Bold tulle, s No* <br /> 10 Proper Preservatives <br /> used a No's <br /> 1I. Tem a(ure Blank Received? Na* <br /> 12 Temp Rec at Lab . c <br /> (Acceptance range for samples <br /> ire uirtn thernial pres 4-N--2°C) es No's ` <br /> 13 Samples collected.more " <br /> [Tian 4 days ago? yes*/ <br /> sampl ipt Lo *if Circa d, contact Pro Manager and attach recdrd bf resolution. <br /> 9 .Revlslo (8/30/ud) <br /> Replaces Revision 21 (11/10/oo) Pana n{ <br />