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f <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOC <br /> - M <br /> CLIENT NAME SH j q __---- DATE RECD AT LA8 i '� g c�C For Regulatory Purposes'? <br /> REC.BY(PRINT) _ tr L(f'LTIME REC'D AT LAB DRINKING WATER YES 1 T <br /> WORKORDER k?A ZE _ DATE LOGGED IN, WASTE WATER YESQ5 <br /> c <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESS V SAMPLE DATE REMARKS <br /> SAMPLE# # CENT ID DESCRIPTION ATIVE pH MATRIX SAMPLED CONDITION(ETC) <br /> 1 Custody Seai(s) trs nt 1 Absent <br /> t/Broken- <br /> 2 Chain-of-Custody FO sent/Absent* <br /> 3 Traffic Reports or <br /> -Packing List Present/Abs6nt <br /> 4 Air btlI SII'/�r i <br /> Present/Absent <br /> 5 Airbill# at ate+' 0 f 0 0(3,3 y© �.�f <br /> 11 6 Sample Labelst 1 Absent <br /> 7 Sample IOs LEtqd/Not Listed ' <br /> on Chain-of-Custody <br /> S Sample Condition 1At9t/Broken*/ <br /> Leaking* <br /> x 9 Does information on chain-of-custody, <br /> traffic reports and sample labels <br /> agree? MI No* <br /> 10 Sample received within <br /> hold time? Xe51 No' <br /> 11 Adequate sample volume <br /> received? leek/Ne' <br /> 12 Proper preservatives used e /No* s <br /> j i 13 Trip Blank/Tamp Blank Received? i <br /> (circle which if es) Yes/LIT <br /> 14 )=lead Temp <br /> Corrected Tamp �l <br /> r Is corrected temp 4 f/-2°C? Yt&/silo`* I� <br /> \ccaptance range for samples requiring thermal pros) � <br /> `Teption (if any) METALS / DFF ON0 ; <br /> Problem COO <br /> �•�� ,� MERE- <br /> 'IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION. <br /> "vision 7 Page of f <br /> Rev 5(07/13104) <br /> +13!05 < <br /> t <br /> R <br />