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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: UCS — DATE Received at Lab, I~ (Drinking water)for <br /> r <br /> REC BY(PRINT) TIME Received at Lab. regulatory purposes: YESINO <br /> r WORKORDER. LOG IN DATE: (Wastewater)for <br /> regulatory purposes: YESfNO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC.) <br /> 1 Custody Seal(s) Present/ bse <br /> k <br /> I 1 Bro en* 2 <br /> 2 Chain-of-Custod /Absent* <br /> 3 Tragic Reports or <br /> F Packin List Present/ serJ <br /> 4 Airbill Airbill l Sticker <br /> Present/ Ise <br /> 5 Airbill# vI f3 <br /> — <br /> 6 Sample Labelst/Absent <br /> 7 Sample IDs s /Not Listed 4/ <br /> o ham-of-Custod <br /> 8 Sample Condition ntac 1 Brokers*/ <br /> Leakin * <br /> 9 Does information on <br /> custody reports, traffic <br /> reports and sample <br /> labels a reel a No* <br /> 10 Sample received within <br /> hold time Ye 1 No* <br /> 11 Proper Preservatives <br /> used Ye / o* <br /> 12 Temp Rec at Lab , d <br /> (Acceptance range for samples <br /> reguinng thermal pres 4+/-2°C) e /No* <br /> *If Circled, contact Protect Manager and attach r Ocord of resolution. <br /> Sample Receipt Log <br /> Revision 2 t (11110100) , <br /> Replaces Revision 2(11/MOO) Page of <br />