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� � s <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME RAIU S DATE RECD AT LAB- A 4 For Regulatory Purposes? l <br /> REC. BY(PRINT) t TIME REC'D AT LAB, sza DRINKING WATER YESO <br /> WORKORDER: M�GD�j S� DATE LOGGED IN: -51,910`P WASTE WATER YES NQ <br /> CIRCLE THE APPROPRIATE RESPONSE LABDASM CONTAINER PRESERV SAMPLE DATE REMARKS. <br /> SAMPLE# # CLIENT ID DESCRIPTION ATIVE PN MATRIX SAMPLED CONDITION(ETC) <br /> 1 CustodySeal(s) Present bse ol A-F MW- I <br /> Intact/Broken* I An BIFIZV,A 4*,S0 <br /> 2 Chain-of-Custod res t/Absent* ML P <br /> 3 Traffic Reports or K I t_ FOLq t4 Noi5 <br /> PackingList Present bs L 1 DAcTi NaX'SLO <br /> 4 Alrbill Airbill/Sticker 02, A-L- lulu!- SAM lc SAMA <br /> Present/ 03 Mw- S <br /> 5 Airbdf#' "�- 0q MW-4 <br /> 6 Sample Labels Pres /Absent OS Mw"? <br /> 7 Sample IDs U. /Not Listed DS. MW -g <br /> pain- - ustody 01 yv- <br /> 8 Sample Condition Intao0l Broken-/ IIA w -10 <br /> Leaking* b A-t= M W. x (; Vok S I+C4 <br /> 9 Does Information on chain-of-custody, o A-'c- M W- it '3 VoA S H-UI <br /> traffic reports and sample labels 1) 1M W - II- <br /> a ree? Ye /No* t i W - t 3 <br /> 10 Sample received withinl M n- 3 <br /> Fold time? Yes No* /4 3 1-$s4(+q 3 f,o 4 *k J oA.5- <br /> 11 <br /> 11 Adequate sample volume <br /> received? Ye /No* <br /> 12 Proper preservatives used? Ye /No* <br /> 13 Trip Blank/Temp Blank Receive ? <br /> clrcfevAlch,If es Y /No* <br /> 14 Read Temp <br /> Corrected Temp S`ice L <br /> is corrected temp 4+I-2°C? (!�)!No** <br /> (Acceptance range for sample$requiring thermal pros) <br /> "Exception(if arty) METALS 1 DFF ON ICE <br /> or Problem COC - <br /> ILI <br /> r *IF CIRCLED, CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION. (� <br /> SRL Revlslon 7 Page of I <br /> Replaces Rev 5(07/13104) i <br /> , <br />