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SEQUOIA ANALYTIC SAMPLE RECEIPT LOG <br /> CLIENT NAME: ��. '��Loi DATE BEG'D AT LAB: For Regulatory Purposes <br /> fIEC. BY(PRINT) V9 TIME RECD AT LAB DRINKING WATER YEs Y 1p <br /> WORKOHDER �1r PATE LOC�G)=l1 fiV: _ WASTE WATER �1 N4 <br /> (Far clients requiring preservation checks at receipt,document here)� <br /> CIRCI. THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESSRVI SAMPLE GATE REMARKS <br /> SAMPLE N CLIENT( DESCRIPTION AMVE PH MATRIX SAMPLED CONDITION ION(ETC,) <br /> 1. Custody Seal(s) Present)QaDw_C VbA <br /> Int t!Broken` WP t <br /> 2 Chain-of-Custody re$e Absent* a5k-fty VN03 <br /> 3 Traffic Reports or <br /> Pacicin List Present been 1}Au►-h g ll SAMS <br /> 4 Airbill Airbill 1 StieKer <br /> Present/ <br /> 5 Airbill# <br /> G Sample Labels re a Absent <br /> 7 Sample!Ds is Not Listed <br /> on Chain-of-Custody <br /> 8 Sample Condition In ac Broken'! <br /> Leaking* <br /> 9. Docs information on chain-of-custody, ._ <br /> traffic-reports and sample labels <br /> a i ee? es foto' � <br /> F <br /> 10 Sample received within MW <br /> hold time? es No-* <br /> i1 Adee:u to sample volume <br /> received Ye 1 No' <br /> `12 Proper Preservatives Mir� 3M ti= C- <br /> A—s- <br /> ? es >Wo` . <br /> 1 Tnp ankl emp Bl Fleceive <br /> (cuclo which.if ate) Yes No' V �, <br /> 114 Temp Rec at Lab: 2�`�J�- [AW-`� 1 t! <br /> Is temp 4+1-2°C? Ne <br /> {Acceptance range for samples req ndng Manned pros) <br /> "Exception(if arty) METALS 1 DIFF ON ICI= v <br /> 9;L— �7 %V <br /> or Problem COC <br /> q e <br /> *IF CIRCLET),CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION. <br /> RL Revision 6 <br /> paces Roy S(007104) Page of � <br /> ,e QVIV04 <br />