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' 1 � F• <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOC <br /> DATE RECD AT LAB' II !64 _ For Regulatory Purposes? <br /> CL18NT NAME` DRINKING WATER YES R <br /> REG 8Y(PRINT) G TIME REG�D AT LAB. <br /> R: DAVE LOGGED IN. 311 ~d WASTE WATER YES NO <br /> WORKORDEF'P <br /> ' I l SAMPLE DATE REMARKS <br /> CIRCLE THE APPROPRIATE RESPONSE t.Ae JDASH CI,IEr1T 1D CON�AINER PRESERY pH CONDITION(ETC- <br /> SAMPLE# # DESGFUPTION t ATLVE MATRIX SAMPLED <br /> 1. Custody Seal(s) Pr nt 1 A <br /> roken* <br /> 2 Chain-of-Custody Absent* ; <br /> II ° II <br /> 3 Traffic Reports or <br /> Packing List Present 1 sent <br /> 4.Airblll AlrbilI I Stic <br /> Present/ <br /> 5 Airbill# <br /> 6 Sam le Labels Pres 1 Absent <br /> 7 Sample IDs: fisted Not Listed II II <br /> on Chain-of-Custod <br /> 8 Sample Condition ct roken* <br /> 9 Does Information on chain-of-custody, <br /> traffic reports and sample label <br /> a ree'? II ! <br /> 10 Sample received within <br /> hold time? <br /> 11 Adequate sample volume II li <br /> received? a II 91 <br /> 12 ProPer Preservatives used'? o* <br /> 13 Trip Blank I Ternp Blank Received? <br /> Ye �) It <br /> GlrCle W111Ci1 if 83 �I II <br /> 14 Read Temp <br /> Corrected Temp, <br /> Is corrected temp 4+1-2°C'? Y S 1 0** <br /> II II <br /> (Acceptance range for samples regdring thermal pres) ,I II , <br /> **Exceptlon(if any) METALS I DFF ON ICE <br /> F-- <br /> ` *IF CIRCLED, CONTACT PROJECT MANAGER ANt7 ATTACH RECORD OF RESOLUTION ; <br /> ,SRL ton 7 Page 1 <br /> R ev <br /> 5(07113/04) <br /> r d <br />