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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> C <br /> LIENT-NAME- DATE RECD AT LAB• Z For Regulatory Purposes? a <br /> (PRINT) C TIME REC'D AT LAB, DRINKING WATER YES <br /> RDER: -� Irl { _ DATE LOGGED IN. - 2 4. WASTE WATER YES O <br /> TH,E APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV SAMPLE DATE REMARKS <br /> SAMPLE# # CLIENT ID DESCRIPTION ATIVE PH MATRIX SAMPLED CONDITION(ETC) <br /> Seaf(s) Present/ bse <br /> a <br /> Intact/Broken* <br /> -Custod Pm t bsent* <br /> eports orList Present I`Asent-) <br /> 4 Airbill Irbil ticker <br /> f Absent <br /> 5 Airbill# Q , <br /> 6 Sam le Labels res Absent <br /> 7. Sample IDs sted/ ed <br /> o Chain-of-Gusto s <br /> 8 Sample Conditionro en*/ <br /> Leaking" if N <br /> 9. Does information on chain-of-custody, <br /> traffic reports and satftp{e labeis <br /> a reel a No* <br /> 14 Sample received within <br /> hold time? Y /No* ' <br /> 11 Adequate'sample volume <br /> received'? Q/No* <br /> i2 P r u e o* <br /> 13 rtp Blank/Tern $� <br /> CRCI9 WhlCh,Ir Y86 nes Q* <br /> 14 Read Temp 9 Yr <br /> Corrected Temp 0. <br /> Is corrected temp 4+/•2°C7 e / c'* <br /> (Acceptance range for samples requfnng thermal pros) y l l <br /> t <br /> *Exception(if any) METALS / DFF ON ICE <br /> or Problem COC <br /> \` h <br /> IF CIRCLED, CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION. <br /> $RL Roviaton 7 <br /> R s Rev 5(07113104) page o <br /> EV 07/19/05 <br /> r , <br />