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_ ! SEQUOIA ANALYTICAL SAMPLE R•ECEI-PT'-LOG <br /> :. <br /> DATE FIEC'D AT LAB: I I 1 A S _ For Regulatory Purposes? <br /> CLIENT NAME; _ y <br /> 1REC.BY{PRINT} OT _ � TWE REC-D'AT LAB:�7 aO DRINKING WATER YES! 0- <br /> ` L'RKORDtR: tpt t e DATE LOGGED IN: >` WASTE WATER YES 1 <br /> J_JRCLETHEAPPROPRIATE RBSPON�;E i.AB RASH coMAINER PRESERV SAMPLE DATE... BE ARKS, <br /> SANipI # #" <br /> CLIENT pH• DkSGRIPTiON ATIVE MATRIX SAMPLED, CONDI ON(C-TC.) <br /> 1.Custody Seals} Pre$ent 1 bse6t- y r o <br /> IpUwQQ3rojk9n <br /> Pop- <br /> 2, Chain-:of-Custody Present Absent* G <br /> . o <br /> 3.iTrafFc Reports or PV A <br /> Packin List: resen Absent r <br /> �.Airbill: Alrbil�nt <br /> ticker <br /> l resAbsent r <br /> 5. Airbill#: In ' -- � <br /> 6.,Sam le Labels: resen Absent <br /> 7.;Sample IDs: Lista Not Listed <br /> _ ain-of-Custod . <br /> 8.,Sample Condition: Intac /Broken*/ <br /> QIn <br /> 8..Does information on chit!ti-of-custody, a - <br /> !traffic reports and sample lab <br /> a ree?' Yes No* <br /> 10. Sam plq received within <br /> hold time? Yes No* <br /> 11.Adegvate sample volume <br /> received? Ye 1 No* <br /> 12. Pro�er preservativas used? es No <br /> $13.Tip-Blank 1 Temp Blank Receive <br /> `cirolawhish'If s) Yes No* <br /> 14.dead Temp: � <br /> ,Corrected Temp: °ej <br /> Is corrected temp 4•rI--200? Yes No** <br /> (Acceplance range for samples requTang th <br /> "*Exception(if any): METALS DI±P ON ICE <br /> or Problem COC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD 01F RESOLUTION. <br /> SRL Revislon 7 " <br /> I Replaces Rev 5(07113104) Page J_of <br />