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$EQUOIAANALYTICAL SAMPLE RECEIPT LOG <br /> •w�a+xn� �ca av r� +—�+Pcma-,- rte• _ vn •a. .i _ _ y a' _ <br /> CLIENT NAME: DATE REED AT LA13: ��[ '0,S For Regulatory Purposes? <br /> REG.BY.(PAINT) TIME REG AT LAB: Ug � I}RIPlK1NG WATER YE <br /> WORI4oRDER: -�n __b`_Z_� _ DATE LOGGED I.M. j - WASTEWATER YES�II <br /> (For clients requiring preservation checks at receipt,document herel) <br /> CIRCLE THE APPROPRIATE RESPONSE LAR DASD CONTAINER PRESERV SAMPLE - 'DATE REMARKS: <br /> SANiFLE# # CLIENT]D� DE5CR1PTI0[� ATIVE pH . MATRIX SA141PLED CONDITION(ETC). <br /> ft <br /> 1. Custody Seal(s) Present <br /> 0 <br /> eta Broken* <br /> 2. Ghaln-of-CustodyPra nfi/Absent* <br /> 3. Trafflc'Reports or f <br /> Paddri _List: ese ! ent —(a <br /> 4. Alrbili:. —?N&III4 fuck <br /> Present:f Absent <br /> 5. Alrhill#:• �j ' <br /> 6. Sam [e Labels: rs # Absent Z <br /> 7. Sample IDs: C1279 )/Not Listed <br /> an aln-of-Custod 2_ 3-�•OS' <br /> 8. Sample Condition: In • I Broken*I t+D" <br /> Leakirl * W, <br /> 9. Does information on chain-of-custody; <br /> traffic reports and sample labels •' -- <br /> s ree? e I No. <br /> 10, Sample received within' <br /> hold t1me? 1 No* <br /> 91,Adequate sample volume <br /> received? Yes No* <br /> 12. Proper Preservatives J <br /> U!2 Ye /No* <br /> Tri ah I.Temp Blank Received? <br /> (circle which,It yes)' f . No* <br /> 14. Temp Rec.at LAb:• �NO**Is temp 4+12°C? <br /> `4 <br /> (Acceptance raPxje for samples requiring therrnai pres.) <br /> **Exception(if any)- METALS / IFF ON ICE <br /> r <br /> or Problem COC <br /> n » SRLRevision'6 r *IF CTIR CONTACT PROJECT MANAGER AND ATTAC H-REC0RD of RESOLUTION. <br /> Replaces Rev 5(09107104) Pagel . <br /> FfFarliva 011 M4 <br />