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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG _ <br /> CLIENT NAMEW DATE RE 'D AT LAB. For Regulatory Purposes? <br /> i REC.13Y(PRINT) TIME RE(1)AT LAB: Q DRINKING WATER YES J <br /> WORKORDER, b�scl <br /> DATE LOGGED IN WASTE WATER YES 1;S <br /> (For clients requiring preservation checks at recelpt,document here ) <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH T <br /> FD <br /> ONTAINER PRESERV SAMPLE DATE <br /> Ri✓i�fAFtI{S' <br /> SANfpLI=# # CLINT Ib SCfiIPTION ATIVIr MATRIX SAMPLED CDi+lDiTit3N(F-TC) <br /> 1 Custody Seal(s) Present ent 61 - Gam-- �' [., '2Z <br /> In• broken* <br /> 2 Chain-of Custody es I Absent* <br /> 3 Traffic Report-,or k r <br /> s <br /> _Packing List Prese 1 <br /> 4 Alrbill' Air b ticloe <br /> res t f ALLsont <br /> G. Airbill# b too 1IRS <br /> E <br /> l 6. Sam le Labels P I Absent <br /> i <br /> 7 Sample 113s: ed/Not Listed <br /> ( on Chain-of-Custody <br /> 8 Sample Conditionn c /Broken*I <br /> re-akin' <br /> 9. Does information on chain-of-custody, <br /> i <br /> traffic reports and sample labels <br /> agree? <br /> 10 Sample received within <br /> hold time (S?No` <br /> 11 Adequate sample vdlume <br /> received? Q,Na* <br /> 12 Proper Preservatives <br /> used? Ye !No* <br /> 1 ri ank 1 Temp Blank Received? <br /> (elrcte which,If yes) No* <br /> t 14 Temp Rec at Lab t� <br /> t Is temp 4+1-2°C? s I NO* <br /> (Awmptance tango for samples requiring thermal pros) <br /> s <br /> "*Exceptton(if any) METALS ! DFF ON ICE <br /> or Problem COC <br /> *IF CIRCLED, CONTACT PROJECT MANAGER AND ATTACH RECiDRD OF RESOLUTION. <br /> SRL Reyslan a <br /> Ropiaces Rev A(11110103) Page , of <br /> Effective MUM <br />