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i <br /> SIE01JOIA ANALYTICAL StllNIPLE RECEIPT LOG <br /> CLIENT NA51U- DATE ReceLved at Lob: .,�. (Drinking►Fater)for <br /> IMC 4Y(PRINT) �. TIi41r Receifed at LAb, ]� lregrilatory I►vrlwses YES►' <br /> WORI{ORDER: i.{)[',IN DATE, °� (Wastewater)for <br /> iegifl story purposes, l'1: r <br /> CIRCLE THF A1113ROMITATI:RESPONSE. LAB SA Al PLIK DATE <br /> SAMPLE# # CLIENT 1D DESCRLPLION MATRIX SAMPUD CONDITION(VI-C.) <br /> I a►study Seaxs) Present 1 Absess WY40L I l VvV JA 3 Z <br /> 2.Cham-of-alstodyras t Absent- v � } <br /> 3.Tra Trio Reports or --WS i Waci } <br /> Packmg Lissy Presartt/ <br /> 4 Airbill- AirNH I <br /> 5 Alrhill#_ ' <br /> &. Sample labels' jjr /Absent C <br /> 7 Sample WS, ,is I Not Listed _ <br /> an Chalwor-Ctsstod <br /> 8. sample om4itim 6fttlBroken*I <br /> i * <br /> 9. Door islrefinattfln on <br /> custody rtprts,traffic <br /> reports and s ample <br /> WIC12 agree? Yes; Nn* <br /> 10. Samplc ncewed widktn <br /> hold time: No* ► <br /> 11. PrapUT Presemlives <br /> used &IN& <br /> 12 Temp Roc at Lab. <br /> (Acceplance range for saetPtes <br /> r <br /> thermal c%-44i?-aC Yes/N0 <br /> "If Circled,contact Projectilrlauager and attitch record of resolulian. <br /> Ssmp!e Reaelpt Log <br /> Rods ion21 isYJowl page-of <br /> tteplaces Revision 2(11fD8W) <br /> rfG ,A. <br />