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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> C,L1EN T NAIVIE. WS DATE Received at Lab: (Drinking water)for p <br /> Its C BY (YItINT) j TIME Received at Lab. �E regulatory purposes- YES/NO <br /> �°ulu�uxllER. ���ii11 _ _ <br /> LOG IN DATE: �( (Wastewater)for <br /> regulatory purposes: YESINO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SA 11PLED CONDITION(ETC) <br /> 1 Custody Scal(s) resent I Abseut- <br /> nt 1 Broken* DIV <br /> 2 Chaw-of-CustodyesAit/Absent* <br /> 3 1tatll(.Reports or <br /> pacLjllg List Present/ t <br /> 4 Anbtll prb, / c r <br /> t 1 Absent a <br /> Anbtll# <br /> b Sala IL Labels res nt/Absent <br /> 7 S,iniplc IDs i d/Not Listed <br /> on Clialn-ol-Custod <br /> R Samph,Coiidillou to 1 Broken*/ <br /> Leakill * <br /> 9 Does mforivatioti on <br /> c.uslody reports, traffic <br /> reports and sample I { <br /> laklsa icel f /No* <br /> 10 Sample iexi-Ved W1111in <br /> ttold lime 1 No <br /> 11 Pioper Preservatives 1' <br /> u5ct! f No* <br /> 12 Temp RCL at Lab <br /> t <br /> a tA(.c.eptatiLe raiige for samples I <br /> i1/uirin , thcriata[ eies 4}1-2°C) 41 No* _ <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revision 21 (1 1/10100) page of <br /> i --- n I n i4 4'Ar-AM <br />