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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> ' CLIENT NAME. TV DATE RECD AT LAS: ('-3-D-0y For Regulatory Purposes? <br /> REC. 13Y(PRINT) �- TIME RECD AT LAB._&L20 DRINKtNG WATER YES I NO <br /> I WORKORDER: kAf 0 0 1, �- DATE LOGGED IN, J1� I I 0 WASTE WATER YES 1 No <br /> } (For cllontS requiring preservation checks at receipt,docuntient here ) <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CLIENT IE] CONTAIK11 PRESERV SAMPLE DATE; REMARKS, <br /> SAMPLE# # DESCRIPTION ATIVE MATRIX SAMPLED COND1TIaN(ETC) <br /> 1 Custody seal(s) Prese Absalf D7177 <br /> x 1 t I Broken" g <br /> 2. Chain-of-Custody CfEeEek 1 Absent' <br /> 3. Traffic Reports or <br /> Packing List' Pas en t <br /> I s <br /> 4 Alrbill Airbill tic <br /> } rese !Absent <br /> t <br /> F 5 Airbdl# , <br /> 6 Sample Labels- Pr nt I Absent <br /> 7 Sample IDs- 4aW I Not Listed <br /> o Birt-of-Gustod <br /> t 8 Sample Condition 41a I Broken*/ <br /> Leaking* <br /> 9 Does information on chain-of-custody, <br /> traffic;reports and sample laAre <br /> agree? 1 No* <br /> 10 Sample received within <br /> hold time'7 I No* <br /> 11 Adequate sample volume <br /> received? 1 No* <br /> M2 Proper Preservatives <br /> used? e 1 Na* <br /> 13 Trip Blank Temp Blank Received? <br /> dile which,if ycs) Yes <br /> 14 Temp Rec at Lab <br /> Is temp 4+1.2°C7 Ye 1 No** <br /> il(Acceptance range for samples requinnp Ihermat pits) <br /> *Exception(If any) METALS I DFF ON ICE <br /> or Problem COC <br /> emom <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION./ <br /> SRL Revision 5 <br /> Page <br /> Replaces Rev 4(11110103) <br /> r-H.Mup nalmind - <br />