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J SEQUOIA ANALYTICAL SAMPLE RECEIPT'-LOG <br /> CLIENT NAME: DATE REC'D AT LAB: /�-S"d� For Regulatory Purposes? �S� f <br /> 1REC.BY(PRINT) ,lP, _ 7iME RECD AT LAB: ,'Y(' - — DRINKING WATEII YES A0 ' <br /> 'WORKORDER: n']�},�A 7$� DATE LOGGED IN, WASTE WATER YES <br /> 'CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV SAMPLE DATE... REMARKS: l <br /> CLIENT ID- pH <br /> SAMPLE# # DESCRIPTION AWE MATRIX' SAMPLED, CONDITION(ECC.) i <br />. 1. Custody Seal(s) Pr@so 1 Abse;1- <br /> I - m:*6101- <br /> t ct <br /> In /Broken* <br /> 2. Chain-of-Custody - res t/Absent* <br /> 3.Traffic Reports or , <br /> Packin List: Pr sent Abse <br /> 4.:Alrbil(: 1 Stickor <br /> F <br /> re t/Absent <br /> 5. Airbill#: <br /> 6. Sarri le Labels: l'r. #/Absent <br /> 7.,Sample IDs: list /Not Listed <br /> ain-of-Custo_d <br /> 8.:Sample Condition: lnt t/Broken-l <br /> ----- <br /> Leaking; <br /> 9. •Does informatlon on chain-of-custody, <br /> ;traffic r=eports and sample In <br /> m ree? Ca/Na* . <br /> 10. Sample received within <br /> hold time? Ye /No4 <br /> 11.Adequate sample volume <br /> received? /Nd* <br /> 12. P QF Preservatives used? !No- <br /> (3. ank Received? <br /> chole which,fF Y /No* <br /> 14.:Read Temp: � r <br /> ,Corrected Temp; c <br /> ils corrected temp 4+12°C? Cje /No- <br /> (Acceptance range for samples requiring thermal pros.) <br /> **Exception (if any): METALS 1 DFF ON ICE <br /> or Problem CDC <br /> f <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD dP RESOLUTION. <br /> I SRL Aevlsbon 7 <br /> I lloplaces W5(07113144) Page of <br /> 4_: <br />.� afw•t;vani7119N14 f _ ( ,4'• 1 `- . <br />