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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOC <br /> CLIENT NAME- DATE RECD AT LAB - For Regulatory Purposesry <br /> REC.BY(PRINT) P TIME REC-D AT LAB. 0,5�� _ DR1IjPNG WATER YES <br /> WORKORDER v1 g 5,2 DATE LOGGED 1N; _�_-l*�—afi WASTE WATER YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CLIENT ID CONTAINER PRESERV H SAMPLE DATE REMARKS: <br /> SAMPLE# # DESCRIPTION ATIVE p MATRIX SAMPLED CONDITION(ETC) <br /> 1 Custody Seal(s) Presentl s 01 . W _ _ 7SCL/ <br /> I /Broken* - td�c.. <br /> 2 Cham-of-Custody- Or t/Absent* '^ Un, IYNo3 <br /> 3 Traffic Deports or ✓ $ <br /> PackingList Presen bse �L yjJW-2-, ��. P <br /> 4 Alrbill i ill Sticker a _F Gu fJD�t �' <br /> Pre e t/Absent �.. � d p <br /> 5 Airbill# i 00)LZj 'Zp-j Ilda, L� <br /> 6 Sam le Labels I Absent p�„ ,,Vp <br /> 7 Sample IDs st /Not Listed k <br /> 2n.Chain-of-Custody �, <br /> B Sample Condition nta t 1 Broken*/ d <br /> Leaking* 6 <br /> 9. Does information on chain-of-custody, o� <br /> traffic teports and sample labels <br /> agree? e /No* p <br /> 10 Sample received withinS�16 <br /> hold time? l No* <br /> 11 Adequate sample volume <br /> received? e /No* <br /> 12 Proper preservatives used? es No* <br /> Lwhe�, <br /> amp BI k Deceived? <br /> hich,If es es No* <br /> emp t= <br /> ted Tempected temp 4+1-2"C? a No" <br /> range for samples requiring thermal pros) <br /> n (if any) METALS / DFF ON ICE <br /> lem COC <br /> 5RL R - <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION <br /> - 7 <br /> Replac v 5(07113104) Page—01 I <br /> Effective 07/19/05 <br />