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i <br /> L Ul }I>> f��l`11��_ t J:I_ L L <br /> �( E_iEkI NAME , I'i' l � L DAI 17i--C'D Al LAH 11�� �Jrj r ul fir (Jrrl itury ljol o 4— - <br /> i IREC BY(PRINT) U�L1.trC_U`_> Z IMIE REC'D AF LAB C) DRINKING WA�I Eft YES ILEO <br /> �WORKORDER Ty,{ y �,q DATE LOGGED IN f/� 1°� °r °� WASTE WATER YES 00 <br /> t I 3 <br /> CIRCLE THE APPROPRIATE RESPONSE LAB JDASH CONTAINER PRESERV SAMPLE DATE REMARKS s <br /> I SAMPLE# It CLIENT ID DESCRIPTION ATIVE pH CONDITION El C t <br /> MATRIX SAMPLED ( ) <br /> I ICustody Seal(s) PresentAtasont w -A 945—L-0 m6,1 C 'IQ s Q ry <br /> Int t/Broken* vv <br /> G 2 Chain-of-Custod Prasen I Absent', d y <br /> 3 ]Traffic Reports or & <br /> Packing List PQuent/Absent v f <br /> 4 'Airbil! Airbill I Sicker <br /> nAb ent 0�, <br /> s 4bdl # 'Z( 2-7%q734b —IDA 11 1 ~_ <br /> t 6 Sample Labels Pres n)1 Absent <br /> 7 Sample IDsListed Not Listed o <br /> r on Cham of Custod " <br /> a Sample Condit= tnta !Broken'/ <br /> i Leaking* <br /> 9. Does information on chain-of-custody, <br /> traffic reports and sample labeile <br /> a realee /No* <br /> 10 Sample recelved within <br /> bald times 11 es No* <br /> 11 Adequate sample volume rl <br /> raceived? kKO1 No* <br /> 12 Proper preservatives useV es!No* <br /> 13 ,Trip Blank l Temp Blank Receive ? y <br /> circle wfttoh,It os Yes Nd` <br /> X14 Read Temp f <br /> Corrected Temp 'j, -7 <br /> t Is corrected temp 4-e-1-2'0? Yes 1 No" <br /> (Acceptance rarrgo for samples requiring thermal pros) <br /> "*Exception(if any) METALS 1 €JFF ON ICE <br /> or Problem COC <br /> r_Iwvlg <br /> SRL Revision 7 *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION, <br /> s <br /> F Rev 5(07113104) • I'aUa o� <br />