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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> M � <br /> a PATE REVD AT I-AB. �`�1 rac For Regulatory Purposes? <br /> CLIENTNAME, � -1 s �• _�.. <br /> REC.BY(PRINT) TIME RECTO AT LAB: 10" r 0 __-_-- DRINKING WATER, YES/NO <br /> WORKDRDER, b` _-- DATE LOGGED IN: ^/�' �' WASTE:WATER YES 1 NO <br /> (ror clients requiring preservation checks at receipt,document]fere�)3 <br /> CIRCLE THE APPROPRIATE RESPONSE LAO DASH CONTAINER Pi1ESERv sAt'nPl.t: �ATty iiEtwnnxs• <br /> SAMPLE CLIfrN7tQ DESCRIPTION ATIVE itiH IAATn[X SAMPLED C01IOiTION(ECC1 <br /> 1 Cvstody Seals) nese Absent d2 , <br /> lntscl 1 Broken` AK - E FE <br /> 2.. Chain of-Ctlstod res$n Absent* I: <br /> 3.Traffic fleports or f; I <br /> padung last. Present 1 e <br /> 4,Alrbill Airbil1 c r <br /> risen Absent W -- 2- <br /> 5. Aiibili# EFS <br /> G Sgale Labels 1 Absent <br /> 7' Sample IDS sted Not Listed 7. c�)L <br /> Cttslrz-nf-Custo <br /> f?5; ►Kt j <br /> 8.Sample Condihon- ntsc Broken*1 <br /> Leaking* <br /> 3. Docs information oil chain-of-custody, <br /> r traffic reports and sample IAbels - <br /> a ran) esI Ne <br /> 10. Sample received within d -00 <br /> hold bme`? 60s too. <br /> 11. Adequate sample volume <br /> received? Yes No* <br /> 12 Proper Preservatives <br /> usod? Yc I No` <br /> 13 TAp Blank!Temp Blank RecelvinM <br /> (CWe which,if yss) Yes I 4` <br /> 14 Temp Flee.at Lab. w <br /> f Is tome 4+/--2°C? es Plo'� <br /> Acceptance iareo torsamples req�unnp l as) ' <br /> Z_:-TXceplion(d any): METALS f DFF ON ICE <br /> roblem COC a - <br /> ` � 'IF CIRCLED,CONTACT pROJr~C7 MANAGER ANE)ATTACH RECORD OF RESOLUTION. <br /> 1 '�. <br /> ' t 'ns6>0 G pop of <br /> .e air 9ev 5 IW6Tlfl4) r <br />