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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> , mri�-�.,�.��..,.;�,r.nel:y151',.:`T-r.�— v'T i;. r„r.—l^-.S a.t`..^�^ ___— _ __i-d�Y,n ”.r. h. fir...-.. r �.- v _ �,......-•--. .n.;o`—�1 ,1 <br /> {CLIENT NAME DATE RECD AT LAB i�j {��Z_ Foo Regulatory Purposes? !{ <br /> lREC. BY(PRINT) TIME REED AT LAS .UCS DRINKING WATER YES/ 5' <br /> j �WORKOflDEfl fid �{ �j3 c �` DATE LOGGED IN /f ! -r�� WASTE WATER YESI D q <br /> /CIRCLE THE APPROPRIATE RESPONSE LAB DASH CLIENT ID CONTAINER PRESERV H SAMPLE DAVE REMARKS 71 i <br /> SAMPLE# # DESCRIPTION AT)VE A MATRIX SAMPLED CONDITION(ETC) E <br /> 1.(Custody Seals) rgsent Abs©nt d fU— 1� Oji <br /> token* &v <br /> 2 Chain-of-Custody PrOSLI 1 Absent* <br /> 3.1 rrafflo Reports or —� <br /> PRokino List Present Abse <br /> 4.'Alrbill` Irblll Sticker �f <br /> /Absent v <br /> 5 Alrbdi fI Z! y <br /> Sample Labels resent Absent R <br /> t <br /> 7 Sample IDsIsted Not Listed a <br /> on haln-of-Custod <br /> 3 Sample ConditionInta token"/ <br /> eakin <br /> 9. Does Information on chain-of-custody, r <br /> traffic reports and sample labqj@ <br /> a res? Ye 1 No* <br /> 10 Sample roce(ved within <br /> hold thna? GD—/No* <br /> 11, Adequate sample volume <br /> received? e /No* <br /> 12 Proper prosorvalIVOG used? 00S)l No* x <br /> 13 Trip blank 1 Temp Blank Receive ? <br /> (clrclo which,€r es Yes No) r <br /> 14 Read Temp r <br /> r Corrected Temp <br /> ,Is corructod temp 4+/-2°C? 1 No"* <br /> (Accoplanro range lar samplos requiring thermal pros) 1 <br /> "Exception(if any) METALS / DFF ON ICI; { <br /> or Problem COC <br /> G�- r .-.Gil-x Ra M1R' /Sia <br /> *IF CIRCLED, CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION <br /> } SRL Revision 7 } <br /> Replaces Rev 5^(07/13104) Page � of 1 <br />