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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: 5 GO �rr� , DATE REG'D AT LAB �'� For Regulatory Purposes? <br /> REC.BY(PRiNT} A-C • _ TIME RECD AT LAB: DRINKING{NATER YES/ 0 <br /> WORKORDER: II`J�G b 9�/� DATE LOGGED IN; WASTE WATER YES O <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV SAMPLE DATE REMARKS: <br /> CLIENT ID DESCRIPTION ATIVE PH MATRIX SAMPLED CONDITION(ETC.) <br /> SAMPLE# # <br /> 1. Custody Seal(s) Present Cu'> <br /> I ntact l Broken* <br /> 2. Chain-of-Custody rase 1 Absent* <br /> 3. Traffic Reports or <br /> Packing list: Present MOM <br /> 4. Airbill: drou Si er <br /> t/Absent <br /> 5. Airbill#: ► <br /> •6. Sample Labels: /Absent <br /> 7. Sample IDs: kgjR Not listed <br /> on Chain-of-Custody <br /> 8. Sample Condition: Wjj�31 1 Broken*/ <br /> Leaking* <br /> 9. Does information on chain-of-custody, t <br /> traffic reports and sample labels <br /> agree? e2 No* <br /> 10. Sample received within <br /> hold time? 1 No* <br /> 11. Adequate sample volume <br /> received? a No* Jr <br /> 12. Proper preservatives used? 1 No* <br />'h 13.Trip Blank 1 Temp Blank Received? <br /> cirde which,If s Yes/No* <br /> 14. head Temp: <br /> Corrected Temp: ' <br /> Is corrected temp 4+1-2°C? (!!51 No** <br /> (Acceptance range for samples requiring thermal pre$.) <br /> "*Ext;ept�an EIt any)' METALS 1 DFF ON ICE <br /> or Problem COG <br /> *IF CIRCLED, CONTACT PROJECT MANAGER AND ATTACH RECORD OF RI+SOI.t1T10N. <br /> MOM 7 � Page*_of <br />