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I <br /> ID"QUOYA ANALYTICAL SAMPLE REC11,11P 1.`LOG <br /> CLIENTNAME.- DATE Received at Lab: L (Drinking wa ter)for <br /> It73C.BY(D1 RIN ) 'Z'xit'1�Itectind at Lab. �� ) _ rcgirlaiary tntrposcs: YENtU <br /> NVORKOlt ER., LOG IN DATE; 113 (Waslelvater)for <br /> rcguialory purposrs- YRS Il <br /> C.URCT,E TRCAPPROPItrATJZ RESFoN.Sig LAB SAMPLE DATEShhTpl.E t/ # CL7F111T IU b].SCR7PTXOAi KA= SA11 TT,Itfl CONDMOI►IQYfC) <br /> 1. Custody Sea](s) Present Ge— 1sdomdo d= <br /> Intact! 11 , <br /> 12 Chain-of-Custody lAlaecnzi 0-1) YY1Lo L,40- <br /> 3. <br /> 4 3.TrafliaRepods or <br /> Paakm List PFrst { <br /> 4.Ahbill Aitbtll f Siic <br /> Present n <br /> S.Airb)II1; <br /> G Sample Labels 1 Alnt <br /> 7 Saniple 1]}s .lst !Not Listed <br /> on Chain-of-Cust <br /> S Sample Condition tact• Brokea* I _ <br /> ing* <br /> 9 Does inforinatiep on <br /> custody reports,tmmo <br /> reports and sample <br /> U&a ? oa <br /> 10 Swupla re arced within <br /> hold time Mo* <br /> I <br /> 11 PrIaper Proservatives <br /> used e !Mo* <br /> 12 Temp Roo of Lk <br /> (Accept.-Mce range for samples <br /> CC frin ttie;tual rea.4+!- Y kNom <br /> I <br /> *If Cirdcd�eontaPrcject Manager and attach rocord of resolutioll. _ <br /> Sample P.M101 Loy <br /> RewIslon 2 t(1111oiDD) <br /> Re Iaoes Revlsiart 2{i flraBlQtl) Page of <br /> f 1112rQti <br />