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i � • <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> x <br /> CLIENT NAME: _ DATE Received at Lab: (fDriolung water)for <br /> REC BY(PRINT) AT T TIME Received at Lab ( r <br /> regulatory purposes YES/NU <br /> WORKORDER �� LOG IN DATE (Wastewater)for <br /> regulatory purposes, YESINO <br /> CIRCLE TIIE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION (ETC) <br /> I Custody Se-al(s) Present/Ase 1n,J Z <br /> Intact I Broken* <br /> t <br /> r 2 Cl►aut-or-Custod P /Absent- <br /> 3 Traffic Reports or <br /> Pactung List Present <br /> 4 Atrbill Airbtll l Sticker <br /> Preseritkiv-STIA <br /> 5 Airblll# <br /> 6 Sample Labels t/Absent <br /> 7 Sample IDs rst /Not Listed <br /> on Chain-of Cest„d <br /> 8 Sample Condition it t I Broken*/ <br /> Lealun * <br /> 9 Does infonnation on a <br /> c4istady reports,traffic <br /> i <br /> reports and sainple <br /> labels a reel 1 No* <br /> 10 Sample received within <br /> hold tone FeV No* <br /> III Pioper Preservatives <br /> t used e 1 No* I <br /> 12 Temp Rec. at Lab <br /> (Acceptance range for samples <br /> ieguiring theiinal )ies 441-2'C) /No* <br /> W'.�a,�cR.r �a>eu Yc r S"S9'' 3 hCNlO:aS@ <br /> *If Circled, contact Project Manager and attach record of resolutiort <br /> Sample Receipt V og <br /> Revtswn')1 (11!10100) <br /> Rephres Ri i nn 2(11106100) Page of <br />