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I - _ <br /> i <br /> SEQUOU ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAM,Es DATE Received at Lab: �' t <br /> (Drinking water)for <br /> REC.BY _ - <br /> � r) TIME Received at Lab: �,�b regulatory purposes: Y <br /> VVOR'ICURDER: LOG IN DATE: d'LI (Wastewater)for `J <br /> regulatory purposes: Y <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDfTION(ETC.)- <br /> 1. Custody Seals) :Present A e W — � 7 <br /> L , <br /> intact!Br sn_ 00 f <br /> 2. Chain of-Cvstod res t I Absent* DZj <br /> 3. Traffic Reports or <br /> P2ELdm List: Present s t (� -- <br /> 4. Airbill: Airbill l Sticker (} �_ <br /> Present <br /> 5. Airbill#: _ <br /> 6. Sam le Labels: (Absent .� <br /> i 7. Sample IDs: TP I Not Listed —L0 <br /> on Chain-of-Casted <br /> 8. Sample Condition: I Broken*I <br /> 9. Does information on <br /> Encustody reports,traffic <br /> reports and sample <br /> D labels agree? No* <br /> � <br /> L0. Sample received witliin <br /> a hold time: Noy' <br /> 11.proper Preservatives <br /> used: <br /> &I No* <br /> 12. Temp Rec.at LAh: (� <br /> N <br /> (Acceptance rangy for samples <br /> Vzera¢al res.;4+12-C) Yes I NO <br /> � *If Circled, contact Project Manager and attach record at resolution. <br /> Sample Receipt Log <br /> Revision 2.1(1 i/10100) <br /> Replaces Revision 2(11106100) Page of <br /> Effective 11/12100 <br />