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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG _ <br /> w �o o For Regulatory Purposes? <br /> I CLIENT NAME 5rMATU S <br /> DATE RECD AT LABr � 14 <br /> 3 TIME RECD AT LAB $�-a DRINKING WATER YtWSO <br /> REC BY(PRINT) Pit o WASTE WATER YES <br /> WORKORDER• Nlt'C.�'J is DATE LOGGED IN- � <br /> x <br /> CQNTAINER PRESERV SAMPLE BATE REMARKS <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CLIENT Ib DESCRIPTION ATIVE pH MATRIX SAMPLED CONDITION(ETC) - <br /> SAMPLE# # <br /> 1 Custody Seal(s) Present 1 bse <br /> o p-� <br /> Intact I Broken* G I AMB�2�o,4 r#Lso <br /> 2 Chain-of-Custodyres t/Absent* <br /> H.� N)M-0—ML—f <br /> P01.1 N Nom <br /> 3 Traffic Reports or 1� t <br /> Packina List Present bs L } eAcTl t�amS�o <br /> 4 Arb€ll <br /> Airbiil l Sticker 02 A-L- MW- SAM G7 SAMr <br /> Present/ku b3 M W <br /> 5 Airbiil# MW-".." <br /> { 6 Sam la Labels�,111,1 Pres I Absent tAW r <br /> 17 Sample IDs List I Not Listed <br /> hain-of-CustOd ti'I MW-9 <br /> r <br /> 8 Sample Condition In /Broken I �& l\A VV t <br /> Leaking0 A- Mw- 2 I: Vok s HIC4 <br /> g Does Information on chain-of-custody, 10 A-L Mlnr r If 3 Vohs 11'Ll <br /> traffic reports and sample labels I) MW I¢ <br /> a ree? Ye I No- t L "VV - 1:3 <br /> 10 Sample received within l3 M W` 3 1 <br /> f <br /> hold time? Yes No* k 3 ThS-4U93(.0f. kvohs <br /> 11 Adequate sample volume <br /> received? Ye o* t <br /> 12 Proper preservatives used? Ye I No* <br /> 13 Trip Blank/Temp Blank Receive ? <br /> (circle which,if yes) Y /No* <br /> 14 Read Temp S <br /> I Corrected Temp LDFF <br /> { is corfected temp 4+1-2°CNo <br /> I <br /> (Acceptance range for samples requirpros) <br /> *'Exception(if any) METALSN ICE <br /> or Problem COC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACK RECORD OF RESOLUTION <br /> . page of i <br /> SRL Revision 7 I <br /> Frepfacos Rev 5(07113104) <br />