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SEQUOIA ANALYTIW SAMPLE RECEIPT LOG <br /> CLIENT NAME: �. f jP-5 111?q DATE RECID AT LAB: For Regulatory Purposes? <br /> k REG.BY(PRINT) TIME RECD AT 1.AI3 DRINKING WATER YES <br /> WORKORDER: txt,( DATE LOGGED IN: g w " WASTE WATER YES N 1 <br /> .._ {For clients raquiOng preservation checks at receipt,document here ) <br /> CIRCLE=THE APPROPRfATE RESPDNSE LAB GASB CLIENT ID CONTAINERPRESERV SAMPLE DATE REMARKS: <br /> SAMPLE 4 # DESCRIPTION ATIVE pH MATRIX SAMPLED CONDITION(ETC) <br /> f 1 Custody Seal(s) nt 1 Absent -00Q� l ' <br /> r I !Broken* r - UdGL <br /> 2. Clain-of-Custad rasn /Absent" W� <br /> 3 Trafftc Rep crts or -- <br /> Packing LIM Present t 4 <br /> 4, Alrbill. Airbill/rEw <br /> &r /Absent <br /> 5. Atrbill#. f <br /> 8 Sample Labels, I' /Absent t.v <br /> 7 Sample IDs' /Not Listed - 1 lv- <br /> on hain-of-Custod i.v ~ <br /> l 8. Sample Condition: < nl /Broken*/ -- <br /> Leakin ' >g J►h t✓ l <br /> 9. Does informallon an chain-of-custody, r <br /> traffic reports and sample labels <br /> agree? r3/No' <br /> i D Sample recolvad within <br /> hold time? Y No' <br /> 11.Adequate sample volume <br /> rocoivad? 9-1 No* <br /> 12 Proper Preservatives <br /> used Ye /No` <br /> 13,Trip Blank/Tamp Blame Deceived? ` <br /> (circle which,d yes Yes N o" <br /> 14. Temp Hoc at Lab: <br /> Is temp 4+1-2*C? No" <br /> (Accep canoe range for sawples requiring lrtiarrnel pros) <br /> "Exception(If any) METALS / DFF ON ICE <br /> Or Problem COC <br /> 'IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACK RECORD OF RESOLUTION. <br /> r'aoa L 01 � _ <br />