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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG � <br /> �I a <br /> DATE RECD AT LAB'_..3��f"6 I _ For Regulatory Purposes? <br /> CLI8NT NAME: d-u DRINKING WATER YES x <br /> REC. BY(PRINT) G TIME REC'D AT LAB.`�I • <br /> DATE LOGGED IN: �I ' �� `~0 WASTE WATER <br /> WORKORDER: YES NO <br /> I <br /> SAMPLE DATE REMARKS <br /> CIRCLE THE APPROPRIATE RESPONSE i.Al3 DAsli CI IENT ID DSS RIP�ION p ATIVEv I MATRIX SAMPLED CONDITION(ETC) - r <br /> SAMPLE# # [ <br /> 1. Custody Seal(s) Pr nt/A <br /> roken* <br /> 2 Chain-of-Custody Absent* <br /> II II <br /> 3 Traffic Reports or II <br /> Packing List Present/ sent <br /> 4.Airblll, Airbill 1 Stic II II <br /> Present/A fII I�ff t <br /> i <br /> 5 Airbill# II p <br /> 6 Sam le Labels Pres !Absent II i II <br /> 7 Sample IDs. tsted Not Listed <br /> aln-of-Gustod � <br /> 8 Sample Condition an Ch <br /> � taken* <br /> 9. Does Information on chain-of-custody, <br /> traffic reports and sample label - II <br /> NIl II 4 l <br /> a ree? o' II I! <br /> 10 Sample received within II I! <br /> hold time? No; <br /> 11 Adequate sample volume <br /> received? e II I! <br /> 12 Pro or reservatives used'? o* II I! <br /> 13 Trip Blank/Temp Blank Received? II II <br /> circle which,if s Ye <br /> 11 I! <br /> 14 Read Temp II II <br /> Corrected Temp, E Mn <br /> k Is corrected temp 4+1-2°C2 Y s l o** II II <br /> � II I! <br /> (Acceptance range ror samples requiring thermal pies) II II <br /> _"Exception(If any) METALS I DFF ON ICE <br /> or Problem COC <br /> -IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLt1TION j <br /> ' Pagel <br /> SRL ion 7^c { <br /> Rep ev 5(07113104) _ � <br /> I <br />