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SEQUOIA ANALYTICAL SAMPLE R-ECEIPT•LOC <br /> 40- gag <br /> ICLIENT.NAME:' DATE RECD AT LAB: 7 O For Regulatory Purposes?�� { <br /> �REC.BY(PRINT). ,,_� > TIME REC'D•AT LA13: �.3 (DRINKING WATER YES <br /> WORKORDER: 1 b ��/ '� DATE LOGGED IN: _ GI ''�'d' WASTE WATER YES 1 <br /> CIRCLE THE APPROPRIATE RESPONSE LAD DASH CONTAINER pRES1=RV SAMPLE DATE-.- REMARKS: <br /> SAMPLE# # CLIENT!D. DESCRIPTION ATIVE RH MATRIX SAMPLED- CONDITION(ETC.) i <br /> i-�Custody S.eal(s) Present &.1 —Z3 0 i <br /> Intap Broken* r C. a►+o <br /> 2. Chain-of-Custody Prase /Absent* <br /> S.Mrsffic Reports or r 1/ =Z P qrh qr1 <br /> Pacidn List: Present Abse <br /> 4. A1rb111: 191rbil Sticker <br /> res I Absent <br /> 5.Airbill#: t 00100'] 5q a W `Z <br /> 6- Sam le Labels: rese I Absent Q} o <br /> 7,Sample IDs: Listed Not Lis ,r <br /> on haln-of-Custod -s —ZO y�� q►►q <br /> e.-Sample Condition: nt I Broken*I — d <br /> aking* - M,Ut,�•-I D-2� - 0 , <br /> 9. Doesinformatton on chain-of-custody, jet •-1 _Zd <br /> traffic reports and sample fabs <br /> No* <br /> 10. Sample received within 1PN - <br /> hold time? es No* <br /> 11- Adequate sample volume <br /> received? /No* <br /> 114 <br /> 2- P er reservatives used? e /NO <br /> i m Blank Received? <br /> drde which,if es O*. <br /> e /N <br /> .Head Temp; <br /> Corrected Temp: <br /> Is corrected temp 4+I-2°C? !3 No** <br /> (Acceptance range for samples requlring thermal pros.) <br /> *"Exception(if any): METALS I DFF ON ICE <br /> or Problem CDC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OP RESOLUTION. <br /> SRL ReAslon 7 1 <br /> Replaces Rev 5(07A3104) Page of <br />