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$EQUCIA,ANALYTIGAL SAMPLE RECEIPT LOG <br /> _ For Re u7Y0 <br /> CLIENT NAME: � � � - DATE l�l=C D A7 LAB: ��'�Is - - 9 <br /> REG.BY.(i'RINT) 1 �GuJ TIME RECD AT LAB:_ Ug 2 j� --' -- DHiHK1NWATER YE990D <br /> WQRECOfiD>rft• DATE LOGGED 1N WASTE W(For clients requiring preservation checks at re ) <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV SAMPLE - DATE REMARKS: ' <br /> SAMPLE# # CLIENT ID' DESCRIPTION ATIVE pH - MATRIX -SAMPLED CONDITION(ETC.).* <br /> 1. Custody Seals) Presents <br /> ' <br /> JnteeV Broken* ' <br /> 2. Chain-of-Costo Pre t/Absent* <br /> 3. Traftic'iieports or <br /> Packin .Ust: ese 1 ant <br /> 4. Airblll:. 7A,rizill 4zc <br /> Present/Absent C� <br /> 5. Alrbili#: J,J <br /> 6. Sam la Labels: ?6i htlAbsent <br /> 7. Sample IiDt: e 1 Not Listed <br /> on aln-of-Custod — 3-?•a►�' <br /> t3. Sample Condition: in /Brokan-/ D— <br /> Leakin " W <br /> 8. Does information on chain-of-oustody, <br /> traffic reports and sample labels j <br /> agree? a '/No* •• <br /> 10, Sample received within' <br /> hold time? 1 Na* <br /> 11_Adequate sample volume <br /> received? (SD No* <br /> 12. Propar Preservatives <br /> use Ye 1 No* <br /> Tri 1_Temp Blank Received? <br /> (riicID winch,If veSl. <br /> 14.Ten'ip Rec.at LAb:- �N00 Is temp 4+1--2°C? <br /> (Acceptance m e for samples requiring tiierrn'al pros.) <br /> **Exception(if.any): METALS 1 OFF ON ICE <br /> or Problem COC <br /> OLUTION. <br /> SRI,1rIEu1510i1 8 r *IF CIRCLED,CONTACT PI�O.fEC7 MANAGER ANO ATTACH'RECORD OF RES <br /> Page _ <br /> Replaces Rev(06107/04) <br /> Firarlivaii711R1114 <br />