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SEQUOIA ANALYTICARAMPLE RECEIPT LOG <br /> CLIENT NAME- UL DATE Received at Lab. -~ `� (Drinking water)for 4 <br /> REC.BY(PRINT) TIME Received at Lab; regulatory purposes- YES <br /> WORKORDER Ba yF3 LOG IN DATE: (Wastewater)for <br /> regulatory purposes- YES/N <br /> CIRCLE THE APPROPRIATE RESPONSE LAB Dash CONTAINER SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION pH MATRIX SAMPLED CONDITION(ETC.) <br /> I Custody Seal(s) a it I Absent <br /> <Vhct/Broken* <br /> 2 Chwn-oi-Custod es t/Absent* <br /> 3 Arrbill A'&]I I Sti6rd <br /> R�ent/Absent <br /> 4 Airbtlt# <br /> s <br /> 5 Sample Labels es t I Absent t <br /> 6 Sample IDs d/Not Listed VVVa <br /> on Cham-of-Custody <br /> 7 Sample Condition I l t I Broken*1 t <br /> Leaking* 0 <br /> s <br /> 8 Does information on custody reports, <br /> ti.iffic reports,and sample <br /> x <br /> labels agree? 1 Noy` � <br /> 9 Sample received within <br /> Bold time Qs!No* <br /> 10 Pi oper Preservatives <br /> used bs/No* r <br /> 11 Teta erasure Blank Received? e 1 No* <br /> 12 1 emp Rec at Lab &gr=C <br /> a <br /> (Acceptance range for samples <br /> MMU'rHig thermal pres 4+1-2°C) e /No* <br /> 13 Samples collected more <br /> than 4 days ago I Yes*// <br /> aq r <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Rsceipl Lag <br /> Revlslon 2 2(8/30104) page of <br /> Replaces Revision 2 1 (11110/00) FIGURE 6b <br /> EifG IVe 9;VU4 <br />