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1 SEQUOIA ANALYTICAL SAMPLE RECEIPT•LOQ <br /> CLIENT NAM5. � � DATE RECD AT LAB:� '61, For Regulatory Purposes? r <br /> IREC.BY(PRINT) _: G TIME RECVAT LAB; d _ 1)131I 106 WATER YES AQ <br /> WORKOR1�1=1�: b DATE LOGGED IN: —G . WASTEWATER YES/ <br /> I /! �Lt <br /> CIRCLE THE APPROPRIATE-RESPONSE .LAB . DASH CONTAINER PRESERV SAMPLE RATE•..• REMARKS: <br /> SAMPLE CLIENT ID• DESCRIPTION ATIVE PH MATRIX SAMPLED CONDITION(ETC-) ; <br /> i.iCustody Soal(s) Pr@sant!A 5 <br /> • ]nta .ken" - - <br /> y 2. Chain-of-Custody t! bsent* ` <br /> 3.Trifflo'Reports or , <br /> Packing List: Presen 1 Abse <br /> 4.'sAirblll: Air 5ti <br /> 5.WrbiA#: d <br /> 6.Sam le Labels: dlreseXLAbsent <br /> 7.:Sample Ids: ste Noi Listed <br /> on ln-of-Custod <br /> B.,Sample Condition: ntac. Broken*! f <br /> Leaking* - <br /> S, i7oesInformation on chain-of cust6dy, <br /> itraffto reports and sample I w <br /> s ree? No <br /> 40. Sample"received within <br /> gold time? Y No* A. <br /> 11.Adequate sample volume " <br /> received? Y o* <br /> 12. P ervatives used? No* <br /> , rip 8Ia Temp Blank Received? <br /> d[cle which,If M)_ No* <br /> L <br /> mp:d Temp:ted temp 4+!-2°G?ge for samples requlrIng thermal pros.) <br /> (If any): METALS / DFF ON ICE <br /> m COC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD Olr RESOLUTION. <br /> . SRl,Revislon 7 ; <br /> F Page _od <br /> Replaces Revs(07I13104) <br />