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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> --_-� <br /> � <br /> CLIENT NAME. � , t L; -11�,�j I DATE RFC') AT LAB �{{ ff +^O� 'y -. y <br /> ' 1 l For Regulatory Purposes? i <br /> 3 I'RFC BY(PRINT) � I TIME REC'D AT LAB 4 I?13INKfNG WATER YES NO <br /> WORKORDEfi I{.�ik {� �'�; DATE LOGGED IN, /1_ 2� ��'f WASTF WATER Y1=5 0 t <br /> 'i <br /> ICIRCLE THE APPROPRIATE RESPONSE LAB —DASH CLIENT tU CONTAINER PRESERV SAMPLE DATE REMARKS <br /> SAMPLE# # DESCRIPTION A71V>; pH <br /> MATRIX SAMPLED CONDITION{E7 CSS <br /> 1,ICustody Seal(s) Present 1 sent i — r D I <br /> I rokon* v <br /> 2 Chain-of-Custody rase Absent* u1 � <br /> 3 ITraftlo Roports or <br /> Packing List Pm—se-pt <br /> q <br /> h 'Ahrblii Airbil / thcker vy <br /> /Absent <br /> S Alrbill;'#. SbIJS q3EI <br /> 6 Sample Labels resent Absentet <br /> 7 Sample Ips sted J Not Listed <br /> o Chain-af-Custod <br /> 6 SampleCandition Intac to en* <br /> eakln * <br /> ry 9. Does information an drain-of-custody, <br /> traffic toports And sample labtkLi <br /> agree? Cas No <br /> 10 Sample rocowed wilhin E <br /> hold t1ma7 a /No* l x <br /> 11 Adequato sample volume l <br /> received? /No* <br /> 12 tiro er prosorwillva3 used? ee/No* <br /> <13 ,Tnp Blank Temp Blank Recowed? <br /> rfrrle whsicii,if es yes J o* v <br /> # <br /> 19 Read ['amp 41� F w <br /> Corrected Tomp, + <br /> Is corrected temp 4+/-2"G? es No"* I <br /> '(Accoptanco range for samples requiring thermal pros) <br /> '*Exception (if any), METALS / DFF ON ICE <br /> or Problem COC j <br /> SR! Ravtslon 7 I *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION <br /> Rcplacos Rev 5-(0!/13/04) Page of <br /> I <br />