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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CJIEN1 NAME: ,( DATE Received at Lab. vl—y —o _ (Drioldtig water)for <br /> REC. BY (PRINT) TIME Received at LaU' t1, regulatory purposes YES/1V0 <br /> WORKORDER LOG IN DATE: 1 Z/S( _ (Wastewater) for ; <br /> regulatory purposes' YES(NO <br /> CIRCLE TnE APPROPRIATE RESPONSE LAB SAIVIPLE DATE K <br /> SAMPLE# # CLIENT Ill DESCRIPTION MATRIX SAMPLED CONDITION(EIC.) <br /> 1 Custody Seal(s) Present! bseu 2 t�11 �1 w <br /> Intact/Bro etch OZ MID- <br /> 2 <br /> IDK2 Chain-of-Custody t/Absent* 1 03, M <br /> 3 Traffic Reports or <br /> Packing List Present <br /> 4 Airbitt Airbilt 1 Slicker — �d1a+- Ba Y tv <br /> i <br /> Present I set <br /> k <br /> 5 Airbill4 Cry tff <br /> b Sample Labels t/Absent <br /> 7 Sample IDS tsl I Not Listed <br /> on Cham-uf-CUstod <br /> 8 Sample Condition t a t/Bioken* / ' <br /> Leakm <br /> 9 Does information on <br /> custody reports, traffic <br /> reports said sample <br /> labels a tee? e /No* # <br /> 10 Sattiple received►vttlua <br /> Bold time !No* <br /> 11 Proper Preserr atwes <br /> used Jlo 1 No* <br /> 12 Terup Aec at Lab 35 <br /> (Acceptance ratige for samples <br /> rc iliFill llteiuial res 4t-/-2°C) /No* <br /> x *if Cir sled, contact Project Manager and attach record of resolution. <br /> Sample Receipt log <br /> D, a-s,. �)4 I!I I I M(N 11 <br /> Paste o _ <br />