Laserfiche WebLink
• SEQUOIA ANALYTICOAMPLE RECEIPT LOG <br /> DATE Received at Lab P ) (Drinking v;ater) for <br /> CL1EN I NAME <br /> REC BY (PRINT) � TIME Received at Lab. 0-06 regulatory purposes YESIN{� <br /> ti�ORKORDER. '� Cs t ! LOG IN DATE: (Wastewater)for <br /> regulatory purposes YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE I LAB Dash CONTAINER SAMPLE DATE � <br /> SAMPLE# # CLIENT ID DESCRIPTION pH MATRIX SAMPLED CONDITION (ETC) i <br /> 1 �r1= le"(' - t� <br /> L Custody Seal(s) Present/ bse <br /> Intact/Broken* <br /> 2 t_liain-of-Custodyr t/Absent* <br /> I Airbiltbil Sticker <br /> res /Absent <br /> 4 Aitbill# 6/f j <br /> 5 Sam h,Labels res t/Absent <br /> G Saniple l Dstl�ts d,/Not Listed <br /> ain-of Custod <br /> 7 Sample Condition nt t/Broken*/ <br /> Leaking* <br /> $ Dots uiloiniation on custody reports, <br /> traffic iepoits,and sample <br /> labels agree? e /No* <br /> 9 Sample received within <br /> bold time e /No* <br /> to ripper Preseivatives r <br /> used e /N2: J o f <br /> 11 Tran erature Blank Re(xived7 Yes/ * <br /> 12 "I emp Rec, at Lab t7— degrees c <br /> t✓ <br /> (Acceptance range for samples <br /> r(quiring tlterinat pres 4+/-2°C) Y 1 Noy` <br /> 13 Samples cullected more <br /> Hiatt 4 da s a o7 Yes *1 <br /> *If Circled, contact Pioject Manager and attach recoid of resolution. <br /> 5arnple Receipt Log <br /> Revision 2 2(8130/04) Page _of <br /> Replaces Revision 2 1 (11/10100) FIGURE 6b <br />