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S • i <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> fi <br /> CLIENT NAME: - DATE Received at Lab: ' 1 Q (Drinking water)for <br /> REC. BY(PRINT) TIME Received at Lab: regulatory purposes: YES/NO <br /> WORKORDER. - LOG IN DATE: Q (Wastewater)for <br /> regulatory purposes: YESINO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX S#WLED CONDITION(ETC.) <br /> 1 Custody Seal(s) TZ=dl Absent NAW — 3�r V <br /> token* <br /> 2 Chain-of-Custody rese 1 Absent* _ <br /> 3 Traffic Reports or <br /> Packing List Presen bsen <br /> 4 Airbill Airbill l Sticker <br /> Present sen <br /> 5 Airbill# <br /> 6 Sample Labels Prese t Absent <br /> 7 Sample IDs ist Not Listed t <br /> on Chain-of-Custody <br /> 8 Sample Condition to Broken*1 <br /> Leukin * <br /> 9 Does information on <br /> custody reports,traffic <br /> reports and sample <br /> labels agree? /No* <br /> 10 Sample received within <br /> k hold time Ye /No* b <br /> 11 Proper Preservatives <br /> used 1 No <br /> 12 Temp Rec at Lab <br /> (Acceptance range for samples <br /> Lau—IrIng thermal res 4}I-2°C) Y No* <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revision 2.1 (11/10100) r,___ <br />