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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME. � DATE Received at Lab,£� � , `�< �V(Diuking water)for � <br /> REC BY (PRINT) A0 TIME Received at Lab. ta` (� regulatory purposes YESINO <br /> WORKORIIER LOG IN DATE. (Wastewater)for <br /> regulatory pugioses• YESINO ; <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAWLED CONDH ION(ETC_) <br /> I Custody Seal(s) Present/ se e g 3 3 <br /> In Broken* <br /> 2 Chain-of-Ciislod e /Absent* <br /> 3 Traffic Reports or <br /> Packing List Present/ bse t <br /> 4 Airbill Airbill/Sticker <br /> Present. sent <br /> 5 Anbill# <br /> 5 Sample Labels t/Absent <br /> 7 Sample IDs rst /Not Listed <br /> o Cliain-of Custod <br /> 9 Sample Condition Int t/Broken*/ <br /> Leaking* <br /> 9 Does inforination on <br /> custody reports, traffic <br /> reports and sample <br /> I�bels a feel <br /> nyeI No* <br /> Il] Sample received within <br /> tiol[Illllle , Na* <br /> Ii Proper Prelervalives <br /> used Y !No* <br /> 12 Temp Rec al Lab 3 <br /> F <br /> (Accel)tance i tinge for samples <br /> Icc stlllll thei mal fres 4�1-2°C} e NO <br /> *If Cir cled, contact Pi o'ect Manager and attach recottl of resoltition. <br /> Samt,le*imnmk og <br /> ;7-,k, <br />