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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> AME• f ' _ DATE Received at Lab _% - 2_ G=� (Drinking water)for <br /> CLIENT N - <br /> # � � n TIME Received at Lab regulatory purposes: YES/NO , <br /> RLC BY(PRINT)+ <br /> ��# � LOG IN DATE- �. '"�-- (Wastewater)for <br /> WORKORDER• r <br /> regulatory purposes- YES/NO <br /> T— : <br /> CIRCLE 1HE APPROPRIATE RESPONSE LAB Dash CONTAINER SAMPLEDATE <br /> SAIIIPLE 4 # C^L�IENT ID `DESCRIPTION pH MATRIX SAMPLED CONDITION(ETC.) <br /> gny � rt t � <br /> I Custody Sealks) Present/AKsen <br /> I q/Broken* f <br /> 2 Cham-of CustodEEes f/Ab <br /> ment* ) t <br /> I' 3 Airb+11 Aubilll tic t 4 <br /> t <br /> resent I Absent i <br /> 4 Atrbill# <br /> 5 Sample Labels l a int/Absent ) <br /> b Sample IDs isted 1 Not Lis ted <br /> o &in-of-Custod #{ 1 / :! oz- ~7 ; <br /> 7 Sample Condition menta t/Broken*1 � <br /> Leakiii * <br /> R Does tntormation on custody reports, <br /> traffic reports,and sample ) <br /> labels-agree" e1 No* Ix, <br /> / <br /> [ 9 Sample received within 1 x ` <br /> hold tine 115s/No* = _ <br /> to Propa Preservatives <br /> E <br /> used �'Y �/No* <br /> 11 Tenn erature Blank Rei eived? s s <br /> k <br /> 12 Temp Rec at Lab -3 g' <br /> f <br /> (Acceptance range far samples <br /> leclutring thermal pres 4+1-2"C) ; Y 1 Noy` <br /> 13 Samples collt,cted tore <br /> F <br /> thait 4 da,s a o" es <br /> *11 Circled, contact Project Manager and attach record of. resolution. <br /> Sample Receipt Log <br /> Revision 2 2(8130104) Page of <br /> Replaces Revision 2 1 (11110100) FIGURE 6b <br /> i=r+ter;ua�;1 04 <br />