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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> LLA <br /> CL111NT NAME DATE Received at Lab `" � (Dnnking water)for ' <br /> r <br /> 1tE( BY (PRINT) TIME Received at Lab. regulatory purimses: YES/NO <br /> WO KORDER. LOG IN DATE, (Wastewater)for <br /> regulatory purposes: YESINO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC.) <br /> I Custody seal(h) es t 1 Absent " <br /> t 1 Broken* <br /> 2 C1laril-of-CustodyCrs t/Absent- <br /> 3 TialIIc Reports or <br /> Pjc.kmg List Present/ e <br /> 4 Airbill Ili/S r <br /> P is nt/Absent <br /> 5 Arrt,rlt# 2 <br /> 6 Sample Labels , nt/Absent <br /> 7 Sample IUs r ist /Not Listed r � <br /> on Cirarn-of-Custod <br /> S Sample Coritlition f ito t 1 Broken*/ <br /> Leakrn <br /> 9 Dues rlrfounation on <br /> custody reports, traffic 1 <br /> reports and sample <br /> labels a reed /No* <br /> lit Simple i=ived willun r <br /> bold time tos/No* { <br /> 11 Ptoper Preservatives <br /> used Y A I W <br /> 12 1errlp Rec aL Lab 3 <br /> (Ac"ptance range for samples <br /> IC(1111111 > thcrinal ries 4+1-2°C) 1 No* <br /> *Il'Circled, coriltact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revision 2 1 (11110100) Page of <br />