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SEQUOIA ANALYTICAL SAMPLE RECEIPT'LOG - <br /> CLIENT NAME _6- � DATE RECD A7 LAB: �-{�D,� For Regulatory Purposes? <br /> lRE0.BY(PRINT) '_ - - TIME REVD-AT LAB; f! � , DRlhll JNG WATER <br /> WORKORDEwR: Lok, b 5?3 DATE LOGGED IN: WASTE WATER Y <br /> CIRCLE THE APPROPRIATE RESPONSE ' LAB DASH CONTAINER PRESERV SAMPLE DATE_ REMARKS: <br /> SAMPLE# # <br /> CLIENT ID• DESCRIPTION ATIVE pH <br /> MATRIX SAMPLED. CONdrFION(ETC.) 1 <br /> 1.ICustody Seal(s) Present e UI7,w7777- 4ZLL -175 <br /> Broken* ) 4 <br /> 2. Crain-of-Custody_ P /Absent* �-� <br /> S.Traffic Reports or <br /> Packing List: Presentlbst3 0• _o G - a' Udc�-1 /�/LL� <br /> A.;Alrbill: Alrbill/Sticker <br /> f <br /> PresentAxiOt <br /> 5,Alrbill##: <br /> G.Sample Labels: e 1 Absent <br /> 7.:Sample Ips: /Not Listed <br /> o aln-of-Custod <br /> S.-.Sample Condition: I ct Broken* <br /> eakln * <br /> 9. hoes information on chain-of-custody, ' <br /> traffic teports and sample labels ~` <br /> area? Y-e /No* <br /> 10. Sample received within <br /> gold time? No* ., <br /> 11.Adequate sample volume <br /> received? ' No* <br /> 12. P=er er resery ? No* - <br /> TriTemp Blan ecei <br /> cl a which,if es 40Y No* <br /> 14.Read Temp: <br /> Corrected Temp: G <br /> Is corrected temp 4+/-2°C? <br /> <s-ANO** <br /> (Acceptance range for samples requiring thermal pres.) <br /> **Exception(it any): METALS 1 DFF ON ICE <br /> or Problem COC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OP RESOLUTION. <br /> SRL Revislon 7 I <br /> l Replaces Rev 5(07113104) Page of <br /> Effective 07/18/05 _ <br />