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a <br /> SEQUOIA ANALYTICAL MPLE RECEIPT LOG ' <br /> CLIENT NAME DATE Received at Lab f (Drinking nater)for ` <br /> RITC 13Y (PRINT) TIME Received at Lab, <br /> ' regulatory purposes YES <br /> WURKORDER. t{C? <br /> C LOG IN DATE. (Wastewater)for <br /> regulatory purposes YE 0' <br /> CIRCLE THE APPROPRIATE RESPONSE LAR Dash CONTAINER SAMPLE DATE <br /> SAMPLE# # CLIENT Ill DESCRIPTION pII MATRIX SAMPLEll CUNDITIUN (EIC) <br /> 1 Custody Seal(s) Present I A sen (d s <br /> Intact/Broken* a <br /> 2 Uimn-of-CustodyPese /Absent* <br /> � <br /> I Acrbill �rr Sticker � <br /> Presen Absent <br /> 61 <br /> 4 Airbill# <br /> 5 Saris le Labe s nese I Absent <br /> b Sample IDs st d I Not Listed <br /> on Chain-of-custody <br /> 7 Sample Condition ntac l Broken*1 <br /> eakin * <br /> S Does Inlotrnatron Un Lustody reports, <br /> u a11-rc,reports and sample <br /> labels a tee's es No* <br /> 9 Sample iecetved within <br /> liold time s NO* <br /> 10 Ptopet Preservati\es <br /> used No* <br /> 11 Temperature Blank Received? e 1 No's <br /> 12 I emp Rec at Lab IS a-grees C <br /> (Ac wptance range for samples lilt L� <br /> teguirttig thermal pies X4+1-2°C) Noy' <br /> L3 Samples collected more <br /> than 4 da s a o? Yes <br /> - h- <br /> *If Circled, contact Pi oject Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revision 2 2(8/30104) Page _ ©t <br /> Replaces Revision 21 (11/10/00) FIGURE fib <br />