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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIEN)C NAME: j DATE Received at Lab' (0-1 (Drinking water)for <br /> lZl.,[: BY (PRINT) <br /> rIME Received at Lab. IC =Ou regulatory purposes. YESINO <br /> I <br /> NVORKORDER + C% LOG IN DATE: `� (Waste"ater)for <br /> regulatory purposes: YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC.) <br /> 1 C ustudy Seal(s) f t I Absent lr - i <br /> 3 <br /> /Broken* s <br /> 2 Chain-o1-Custod nt/Absent* 5 <br /> 3 rralTic Rcports or <br /> PaUnig List Pr eui/A6st <br /> 4 Aiibill 111 S <br /> P t/Absent <br /> 5 Anblll# N bicip I OC 290 1094 t <br /> G Stam Ic,Labcls ese !l Absent — I e <br /> 7 Sainple Ills ed/Not Listed <br /> on Cliam-of Custod <br /> 8 Sample Conaluon It t f Broken"f <br /> Leaking* <br /> 9 Does information on <br /> LUStUdy IGP01IS, tiatfic <br /> repots and sample <br /> labfdS a iee7 /No* p <br /> 10 Sample ieceived within <br /> hold Lutir, f No* <br /> J <br /> I i PI Opel Preservatives <br /> list i� f4s l No* <br /> 12 Temp ltec; at Lab , <br /> fi <br /> (AL,Leptance 1a11gc for samples a <br /> is <br /> jrj&jg Illernlal PTCs 4+1-2°C) e/No* ' <br /> *If Circled, contact Project Maga er and attach record of resolution. <br /> Sample Receipt Log <br /> Revision 2 1 (11110100) Page of <br /> pt ptar e5 ReA%Aun 2(11 196M) <br />