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i <br /> • • s <br /> SEQUOU ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME' Vt 3 ~' DATE Reserved at Lab: (Driulung water)for <br /> REC.BY(PRINT) _ TIME Received at Lab: , regulatory purposes: YE5lNO 4 <br /> WORKORDER. _ LOG IN DATE. --�3 (Wastewater)for <br /> { regulatory purposes: YESINO <br /> o- <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC) <br /> t I Custody Seal(s) Va <br /> t/Absent - 2 <br /> /Broken* <br /> 2 Chain-of-Custod e t/Absent* / 3 <br /> 3 Traffic Reports or <br /> Packing List Present I se <br /> < 4 Airbill Airbill l Stic er <br /> Present 1 Ott <br /> 5 Airbill## <br /> 6 Sample Labels ese*/Absent W\AJ-5 <br /> 7 Sample IDs 2st /Not Listedwn-of-Custod <br /> 8 Sample Condition IQ I Broken*1 <br /> Leaking* <br /> 4 Does information on IV <br /> custody reports, traffic <br /> reports and sample <br /> a <br /> Iabels agree? ' f No* <br /> 10 Sample received within <br /> hold time est No* <br /> I <br /> 11 Proper Preservatives <br /> used 16s!No* <br /> w 12 Temp Rec at Lab <br /> (Acceptance range for samples <br /> r Minng thermal pres 4 F/-2°C) V�3 l No* <br /> *If Circled, contact Pro ect an a ach record of resolution. <br /> I <br /> Sample Receipt Log <br /> Revision 21 (11110100) Page of <br /> Replaces Revision 2(11106100) <br /> Effective 11!12/00 <br />