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SEQUOIA ANALYTIA SAMPLE RECEIPT LOG <br /> f <br /> ( DATE Received at Lab: _ l f G/ _ (Drinldng water)for <br /> I NAME' r <br /> It�;t; 131:` (PRINT) C V TIME Received at Lab* V0regulatory purposes: YESlI'd0 <br /> (Wastewater)for <br /> 1VORKORDER: t Lt 1 -7 1 LOG IN DATE: i t lin/0 t� <br /> regulatory purposes: YES/NO <br /> CIRCLE IME APPRO RIATE RESPONSE LAB Dash <br /> CONTAINER SAMPLE DATE <br /> SAMPLE# ## CLIENT ID DESCRIPTION pH MATRIX SAMPLED CONDITION(ETC.) <br /> Z. 10q <br /> 1 C'ustudy Sealts) Present 1 sent EV <br /> 7. <br /> Intact 1 Broken* ,I <br /> c hails 01-Custod r t 1 Absent* <br /> ---5 <br /> 3 Allblll 1 Sticker <br /> /Absent <br /> rl Anl�lli#! '� � �3e.3 �13 Salle It,Labels t/Absent <br /> Sample IDs t •d 1 Not Listed <br /> on Chain-of-CustodyI ` <br /> e Condition I Broken' / <br /> 7 Sample , <br /> Leaking* <br /> 8 DOLS infotnlalion oil custody reports, <br /> I'I 1 <br /> 1,441fi.tcpolts,and sample <br /> labels a lee J /No* i f <br /> 9 Saitiph,lecei%ed within <br /> —hold tune D—/No* <br /> 10 l3u,pLt Preservatives <br /> usCd ,No* I r I <br /> L 1 1 Flu,Li awke B Link Reeetved'7 Yes 1& f I <br /> 12 I.�i p Rec at Lab Z-11 degrees o <br /> (k"Cptallce tarige fol samples ; �f { <br /> sec uti ink ll�eiirla! les +1-2 C} 1 No* <br /> 13 '� �1w113lcs colluUad Diose <br /> (11,111I das aro j Yes *1 <br /> MYX• .0 vk -LrN wrb5`e M�._ f4 w-R ivcm R,�Yis..sa-• F:_,+^nom <br /> *If Circled, contact Project Manages and attach record of resolution. � <br /> S��lrple Receipt Log <br /> f1G ribion 2 2(8130104) Page <br /> napiat-es Revision 2 1 (11/i0100y FIGURE 6b <br /> Elkoutnve 9;1104 <br /> I ' � <br />