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SEQUOIA ANALYTICAL SAMPLE R•ECEIPT`LOG <br /> CLIENT NAME: 0 _ DATE R1 C'D AT LAB; I j I 114 S For Regulatory Purposes? <br /> IREC.BY(PRINT) TIME REC'D'AT LAB: .7 DRQjKJNGWATE14 YES 1 O <br /> 'WORKORDER: DATE LOGGED]IN, WASTE WATER YES] p <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV SAMPLE DATE,.. • REMARKS: <br /> SAIpi# 4 CL(LNT ID DLSCRIPTION ATIVE PH MATRIX' SAMPL€D 'CONDITION(a <br /> C.) l� <br /> 1 1.Custody Real(s) Prgsent 1 b$ehit d --4Z 4 1 <br /> ! Broken <br /> 2. Chain-of-Custody Present Absent* <br /> I <br /> 3.i`Fraffic Reports or <br /> gu <br /> Packin Lis#: resent Absent A ;y <br /> 4.'Airbill: _ AirbM Sticker .- <br /> ' resent Absent 14J/ ve,9414 <br /> 5, Airbill fk: b In 99 V pq �" <br /> fi. Sam le Labols: resen Absent f' <br /> 7.-Sample IDs: taste Not Listed <br /> IM*ain-of-Custod <br /> 8.:Sample Condition: Inta I Broken*I <br /> 9. Does information on chain-of-custody, <br /> E traffic teports and sample lab <br /> agree? Yes No* <br /> 10. Sample,receNod within <br /> . hold time? Yes No* <br /> 11.Adequate sample volume - <br /> received? Yes 1 No* <br /> 12, Pro oer preservatives used? es No* <br /> 13.Tdp-Blank I Temp Blank Recelve <br /> circle whEch,it yes) Yes No <br /> 14.Read Temp: <br /> .Corrected Temp: ° <br /> .Is corrected temp 4+1200? Yqs <br /> (AcsepUMe range for samples requiring th <br /> *"Exception(if any): METALS �qN <br /> a or Problem COC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF i tE50LIJTION. <br /> SRL Revision 7 <br /> l 'Replaces Ftev5(07113/04) Page_ al <br /> T t.crc•..a:.o n7rsulnK a _ _ g <br /> '�'i• � • 1, �:�• � r �_.-rrb �. i.^.�.� I.s«.w+ � 4m••�ht� L� ��rr Y..+.wM � �r `� <br />