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SEQUOIA ANALYTICAL SAMPLE RECEIPT'LOG <br /> JCLIENTNAM•E•' i�,7 DATE RECD AT LAB: For Regulatory purposes? <br /> © DRI KING WATER YEo <br /> AEC.BY(pRfNT). . �^QS _ TIME RECD AT LAB: ,, <br /> I ' <br /> WORKORDER: DATE LOGGED IN. /�" a' WA$TE WATER YES 00 <br /> CIRCLE 73iE APPROPRIATE RESPONSE LAS DASH CONTAINER PRESERV SAMPLE DATE• REMARKS: <br /> SAMPLE# # CLIENT1D• 1}ESCRIPTION ATIVE RH NMATRIX SAMPLED' CONDITION(ETC.) � <br /> 1. Custody Seals) Prgdent lsent a <br /> Intact/Broken" �o, <br /> 2. Chain-of-CustodyPray /Absent' <br /> 3.iTraffic Reports or <br /> Packing Inst: Pr en bsen <br /> 4.;'Airbill: Alrbill/ cker <br /> \Qmspd/Absent <br /> 5. Airbill fk: f SV77 <br /> fi.Sam le Labels: /rre_sdTiW Absent <br /> 7. Sample II3s: %on <br /> d 1 sted <br /> halm-of-Custad <br /> 8.Sam pie Condition: In#a . roken*l <br /> Leaking* <br /> 9. Does information on chain-of-custody, <br /> traffic reports and sample labeis <br /> a rae? Ye 1 Noy <br /> I o. Sample received within <br /> hold time? (Yej 1 No' h <br /> 11.Adequate sample volume <br /> received? I Noy <br /> i <br /> LTRaad <br /> Proper preservatives used? Yes No* <br /> lank/Temp Blank Received? <br /> v�hlch,if yam) Yes! o" <br /> Temp: <br /> cted Temp: <br /> rrected temp 4-N-2°C? Ye 1 Nom*e range for samples requlring Thermal prem.) <br /> ion(if any): METALS 1 DFF ON ICE <br /> roblem COC <br /> "IF CIRCLED,CONTACT MR20JECT MANAGER AND ATTACK RECORD OP RESOLUTION. <br /> SRL Renislon 7 Page A_of <br /> Replaces Rev 5(47113104) <br />