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SFQUOJA ANALYTICAL SAYOLE RECEIPT LOC <br /> ` CL NT 1VAI1MDA'T'A Reoelved at Lab: <br /> Drittling water for <br /> RLC.BY <br /> {i'REIT1 _ �� „ 'I',YM-ieeeaved at Lab: t1cxj, reg::latnry puipases: YES/60 I <br /> WORKORDER: OG DA'C'E: vim. � Wastcwatcr for <br /> regulatory purposes: TES, <br /> CMCI U TU A'PI ROP UTH IMSPONS2 EAB coNTA ER SM)OLE DATE R KOKS: <br /> SAMPLE# # CLENT D) DVSCRrpTYOjq X&TRM S_41VV ED CON-DTnO--4 TC. <br /> 1. Custody Seal{s} }?rosct/ bs q,i/ Ucrp� <br /> ktut{BrOktm" <br /> 2. ChSiD-of Cuswd nt 1 Absent'" <br /> j S. Traffic Rcpmts o <br /> T'acldn Last• Present f s t � - <br /> 4. AirbiU: A libdll!Stickel <br /> Present! as t <br /> i <br /> 5.AirbiIl#- <br /> 6. &mple habeas: 062it I Absent <br /> 7. Sample Ms.. Sd(Not LiMd , <br /> Win.-of.G�st�adv <br /> 8. Sample Condition: t!Brokm*f <br /> 9. Does ia1`urmadon ou <br /> eustodyrvofts,tml iC <br /> reports and samp q <br /> labels ce? Ye f Now <br /> 10. Sample receivedwithiu <br /> hoId time. Yes Nay' <br /> 11.P;'oper Preservatives <br /> used: Y f Nay <br /> 12. Tamp Rec.at Lzb: <br /> (Acceptlaoc mage fvr samples racuiringtherrnak vroF.) <br /> �W&COption(if arty):MC124!)3)�F on icc?IMP no ice? <br /> or Probl=CDC <br /> xi *If Circled.contact Pr2ject Manmer and attach record of resolution. <br /> ` Sampt'e Reoeip:Log - — - - - ' <br /> Revisior12.3(12123102) <br /> o Replaces Revision 2.1 (04111102) Pagel�OP <br /> k ` Effective 12124102 <br /> I � ' <br /> ' I <br />