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• 0 s <br /> SEQUOM ANALYTIC-AT,SAMPLE RtECEIPT LOG <br /> / •J A w'w •S YIn\rt .r Yf MV \ • r A • r , <br /> CLILN,r NAME. -_ "Sp - ••`Ill I K Received at Lsb: � (Drinking water)for <br /> RNC.RY(PIt1N I) _ �. TIME Rece[wd at Lab. i cgulator) pw poses, YJPII ` <br /> WOMORDIrIC: I OG UN DATE' 3 ffaYtewnter)for <br /> k <br /> regulatory pm poses Y } <br /> CJ RCLP.'I 11 S APP110111RU UTLr WEIGNSF, UAIII SAMPLE DKER <br /> SAMPLKII 11 CLIEN t ID D>rSCRTMFOie MATRIX SAMPLED CONDI IION(Efc) <br /> t CustodySenl(s) Prc4ant/Ab at • '� t 7 $ <br /> Intact I Jlrckcr* <br /> Chane or-L'Wied rest f Abscnt�' ; <br /> 3 TraWre Reports or <br /> Parkin List: Present I <br /> d Airbrlh A�rlet`lll �` k <br /> = Prosent! <br /> S Airbill P. <br /> G. Sample Labels_ f Absent <br /> 7 Sampla[Ds st f Not Listcri <br /> I <br /> on C hahi-of Custod ' <br /> S Sample Condition AM4 Broken*1 <br /> 4 Does mformation on <br /> 4 <br /> custody repurts,lrnffc <br /> reports acid sanipla <br /> labels a eco? a No* _ <br /> 10 Snruple received within <br /> holdttme es No* _ <br /> 11.Proper Prestrvlltves <br /> 1-- <br /> used- <br /> 12 <br /> sed•l2,Tcmp Ret:,at 1 air ' <br /> I(ALceptance rtutgo for saiupies <br /> ' <br /> !Muirhig thermal res 4 U-209 Yes I Noy <br /> *If CIIIcled,contact Project hal"Inager and attach record of resolution. <br /> -Sample Receipt Lcq <br /> Rcvlslah 2 1(I I 1101 <br /> Replaces Ravlsbn 2(1IMM) Rage of <br /> Effarttye 1111210D <br />