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�t <br /> SEQUOIA ANALYTICAL SOPLE RECEIPT LOG ll 4 <br /> n y For Regulatory Purposes! ` <br /> qs DATE REC'D AT LAB- <br /> CLIENT NAME: �.v DRINKINGWATER YES 1 , <br /> RE <br /> TIME <br /> REC.BY(PRINT) TIMECD AT LAB' !1 <br /> DATE LOGGED IN: <br /> -x " i��r� WASTE WATER YES�1� i� <br /> WORKORDER: M Ph b VS r� <br /> e <br /> REMARKS- <br /> CONTAINER PRESERV <br /> SAMPLE DATE REMARKS: <br /> CIRCLE THE APPROPRIATE RESPONSE LAS DASD CLIENT ID CONDITION(ETC.) 1, <br /> SAMPLE# # DESCRIPTION ATNF PK f4lATHIX SAMPLED <br /> S <br /> 1 Custody Seal(s) Present/Abs <br /> rota oken* <br /> 2 Chain-of-Custod a Absent* <br /> 3 Traffic Reports or <br />� packiTl List Pr <br /> 4 Airbftl I I ticker X <br /> r Pr Absent <br /> 5 Airbl{1# <br /> r. <br /> 6 Sam to Labels i Absent 4 <br /> 7 Sample f Ds s /Not Listed {, <br /> on Chain-of-Custod +l <br /> S Sample Conditionntac 1 Broken"/ <br /> Leaking* <br /> 9. Does intormation on sham-of-custody, ` <br /> traffic reports and sample labels <br /> a reel es No* <br /> 10 Sample received within <br /> hold <br /> i ) <br /> 11 Adequate sample volume ' <br /> received a No* 4 <br /> l� <br /> 12 Pro or reservatives used? a No* <br /> r 13 Trip Blank 1 Temp Blank Received? n <br /> circle which,it Yes) <br /> Yes/ <br /> 14 Read Temp <br /> Corrected Temp` 4- <br /> is corrected temp 4+/-2C? <br /> (Acceptance range for samples requinng thermal pros) 3 <br /> *'Excepton (if any). M)=TALS 1 DFF ON ICE <br /> or Problem COC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION <br /> Page ! of <br /> SRL Revision 7 i <br /> Replaces Rev 5(07/13104) 1i <br /> `ffective 07/19/05 <br />