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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> # FWOIRKORDER. <br /> NT NAME: DATE Received at Lab. (Drinking water)for s <br /> TIME Received at Lab: regulatory purjtoses• YES/NO <br /> . BY(PRINT) <br /> amp <br /> 7 O LOG IN DATE' —0'3 (Wastewater)for <br /> p regulatory purposes: YESlNO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB i SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDI±N(ETC) <br /> k <br /> I Custody Seal(s) Presen�Eroken*,/ o <br /> Intact <br /> j 2 Cham-of-Custody �bsent* <br /> t <br /> 3 Traffic Reports or <br /> + PackingList Present! j <br /> a 4 Airbill Airbt117 ticker <br /> Present sent V <br /> { 5 Airbill# <br /> d 6 Sample Labels t/Absent <br /> s <br /> ,7 'Sample IDs /Not Listed <br /> on Chain-of-Custody <br /> ,8 Sample Condition /Broken*/ <br /> k , <br /> = Leakin * <br /> 9 Does infornkluon on <br /> custody reports,traffic <br /> reports and sample <br /> labels agree? 1 No* <br /> 10 Sample received within r <br /> hold time /No* <br /> z 11 Proper Preservatives <br /> used ly No* <br /> 12 Temp Rec at Lab <br /> (Acceptance range for samples s <br /> e uinn lherinal res 44-/-2°C) —A/No* <br /> u ww< n _ <br /> *If Circled, contact project nd attach,record of resolution. <br /> 3 Sample Receipt Lag , <br /> RevEsfon 2 l (11/10100) F <br /> Replaces Revision 2(11/06100) Page of <br />