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I <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: DATE Received at Lab- 11 water)ater)for <br /> 1EG BY(PRINT) TIME Received at Lab• �J regulatory purposes XESINO <br /> WORKORI)PR 2 LOG IN DATE: I W (Wastewater) for <br /> i regulatory purposes: YESINO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE D'TE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMP ED CONDITION(ETC.) <br /> I Custody Seal(s) Presen A <br /> R- 111h163 I <br /> s Intact 1 Broken* <br /> 2 Cliam-of-Custod resen /Absent* <br /> 3 Traffic Reports or <br /> Packing List Present - <br /> 4 Airbill Atrbill/Sinker KAI D— E � <br /> Presen bse -Y 2 <br /> 5 Airbill0 <br /> Q 6 Sample Labels Prese Absent EDO P_ <br /> 7 Sample IDs Ltst Not Listed (U44 o <br /> on Cliarn-of-Custod <br /> 8 Sample Conditioit /Broken*/ <br /> ea n * <br /> 9 Does nifoimalton on <br /> F <br /> custody reports, traffic <br /> reports and sample <br /> r <br /> labels a rte? (0/No* <br /> 10 Sample received within <br /> Bold titne fi�/No* <br /> It Proper Preservatives <br /> used I No* ' <br /> 12 Temp Rec at Lab <br /> (Acceptance range for samples <br /> rc uirii► ilteiival rrs 4+/-2°C) Y !No* <br /> *If Circled, contact Project Manager and attach r ecord of resolution. <br /> Samp1 eeetpt Log <br /> I Re > (111147D0) � Page <br /> I <br />