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SF.QIJOIA ANALYTICAL SAMPLE, RT+:(:EIP'r LOG <br /> CL11ENT NAMP DATE Remicid at Lab, JJ }7 (Tlnnkrng~tinter)for <br /> REC BY(P10141) (+ TINIL Received at Lab: Ras regulatory purposes- I 6& <br /> WORKORTN:Tt: w l e � T� Lo(.1N UAIV (Wastenater)for <br /> regulatory purposes: YF �V(? <br /> CIRCLE TING APPROPItirATR!tMPClNSL LAB S AMPLE DATE <br /> SAMPLE 0 # CLII:I�T D7 DF��CTtl1''fIOiV MATRIX SAA1�'LLD CONDITION(FITC,) - <br /> l.Custody Se.l(s) Present bsc 16 I a rr%(,.)— ) 1 , ` <br /> Intact I Dr <br /> 2 Ch uTt-of--Cu og Prese t1Absent* D i <br /> i 3-Trafrw Reports or 0 .t! <br /> Pa.ckin T.Tsf Prescnt en <br /> ULL <br /> 4.Altbdl Abbill 1 tic er a (� <br /> Present set ..' , <br /> I S Airbin t}. 08 <br /> G Sampini analq /Ahwcnt <br /> - E 7 Sample TE]S �yId 1 Not Usted t <br /> s <br /> r <br /> 3 Sample Condition Fdath1 BrokcnO 1 s <br /> 19 Does mfoiinafian on <br /> custody reports,ifafiic <br /> reports and snrnple �{ — <br /> Tsbc2s agree? a [No* <br /> t(Accepftnce <br /> Stmiptc received within <br /> hold time c9 No* <br /> Proper Preservatives <br /> SCI: r NOS <br /> lei iap]tee at Lab E <br /> range far samples <br /> rin thermal tcs.34+f-20C) Yes l it*rT• <br /> Mwwww, r �IR <br /> "If Circler) contact Project Manager and attach ireeord of rcinlufioe, <br /> Sample Receipt Log <br /> Rey3sW 21(11ION00) <br /> Reptaeea Revision 2 tt 1 M001 Page of <br /> cm.a-�1liy MYff <br />