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i <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT E. _ UIQ�AR� DATE REC'D AT LAB. tv Va, ci�r For Regulatory Purposes? <br /> AEC BY(PRINT) PIS- TIME REC'D AT LAB. 1006 DRINIONG WATER YE NO <br /> WORKO13DER: Mof Z IE DATE LOGGED 1N: L6--6s- <br /> ^6-a s~ WASTE WATER YES NO <br /> (For clients requiring preservation checks at racelpt,document here ) <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DA5Ii CONTAINER PRET ERV SAMPLE DATE REMARKS• <br /> SAMPLE# CLIEN t 1D DESCRIPTION ATNE pH MATRIX sAMpLED CONDITION(ETC.) <br /> 1. Custody5eal(s) Present! <br /> i <br /> 1 Broken* <br /> 2. Chain-of-Custody P nt 1 Absent* <br /> 3,Traffic Reports or <br /> Packing List P t 1 <br /> 4 Airbill, Sticker <br /> LPreseRt!Absent <br /> S.Alrblll <br /> S.Sam ie Labels enC 1 ent <br /> 7 Sample IDs, s e /Not tJsted <br /> Cham-of-Custody <br /> 8. Sample Conditlon: lnta 1 Broken*/ <br /> akin <br /> 9. Does information on chain-of-custody, <br /> traffic reports and sample 1 <br /> agree? M1 No* <br /> 10. Sample received within <br /> hold time? Ye 1 No* <br /> 11 Adequafe sample volume <br /> received? Yes No* <br /> 12. Proper Preservatives <br /> used? Y 1 No* <br /> 13.Trip Blank/Temp Blank Receiv <br /> circle which,If2s) Ye /No* <br /> 14 Temp Rea,at Lab, •V'C' <br /> Is temp 4+1-2°C? Ya /No** <br /> (aocaptancs range for samples requiring thermal pres) <br /> "Exception(if any): METALS / DFP ON ICE <br /> QrProblem COC SIX <br /> *IF CIRCLED, CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION.SRL RBVIsio116 Page <br /> Raplaoes Rev S(0ero7/o4) <br /> Effecilve 07/13/04 <br />