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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME- BP DATE Received at Lab, (Drinking water)for <br /> RLC. BY (PRINT) TIME Received at Lab, regulatory purposes: YES/NO <br /> WORKORDER (D-JU3 LOG IN DATE: 7 (Wastewater) for <br /> regulatory purposes: YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAYPUED CONDITION (ETC) <br /> 1 Custody Seals) Presen Abseil Y <br /> Intact/Broken* y <br /> 2 Chain-of-Cuslod re n /Absent* <br /> 3 Traffic Reports or <br /> Packing List Preseii Absei <br /> 4 Airbill Airbill/ Sticker <br /> 1'reseirt Absei <br /> 5 AnbM 4 I <br /> G Saiii le LabelsPre i /Absent <br /> 7 Sample IDsis /Not Listed <br /> I <br /> ,mL <br /> Clialii-of-Custod <br /> 8 Sample Conditionto Broken*1 <br /> Leakm * <br /> 9 Does information oii <br /> Custody repoits, liallic <br /> mpoits and sample <br /> labels a ice? e /Nw' <br /> 10 Sample rcceived within <br /> hold tulle �/No* � <br /> 11 Pioper Preservatives {� <br /> used /INo* <br /> 12 1 emp Rec at Lab <br /> (Acceptance range for samples <br /> t <br /> ie uirin g thelia! res 4+/-2°C) 6)4No* <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revision 2 1 (11/10100) page of <br /> penis,n�Ae na nn')ra T mfimm <br />