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SEQUOIA ANALYTICAL SAMPLE RECEIPT'LOG = <br /> 1CLIENTNAME:: _ DATE REC'D AT LAB; 15 'For RegulatoryPurposes? <br /> I <br /> �REC.BY(PRINT) L/'� TIME REC'O'AT LAB: _730 DRRI KING WATER YRS/ <br /> 'WORKORDER: ROL V4 y !TATE LOGGED 1N: '�_--�}-- �� WASTE WATER YES I <br /> ICIRCLE THE APPROPRIATE RESPONSE LAS JDASH CLIENT ID CONTAINER PRESERV pH SAMPLE RATE,.- REMARKS: <br /> SAMPLE f1 # DESCRIPTION ATIVE MATRIX SAMPLED CONDITION(ETC.) <br /> 1.Custody Seals) Prasent sent 6j 15-04(63-110 - UOe I Ii a <br /> Intact/Broken" <br /> 2. Chain-of-Gusto resen Absent* °— 0aa <br /> 3.{Traffic Reports or - VO4 <br /> Packln Llst: F' sen �''1 t, `Z ,k� 519 n,e- <br /> 4 <br /> - <br /> 4. Airbill: Airb1 Sticker l►� tri•, <br /> es /Absent <br /> 5, Alrbill#: [�} <br /> 6. Sample Labels: rese 1-Absent <br /> 7. Sample lids: stad <br /> on haln-of-Custo_d <br /> 8.�Sarnple Condition: ntac /Broken*/ <br /> e a i n <br /> 9. Aoesinformation on chaln-of-custody, <br /> traffic reports and safrmpie]abe <br /> - agree? ss/No* <br /> 10. Sample.received wlthin <br /> hold time? Y Noy` <br /> 11.Adequate sample volume <br /> received? /Nd* <br /> 12. Proper Preservatives us (YeXI No* - <br /> 13, p Blank/Temp Blank eceive '? <br /> circle c , yes eS No* <br /> 14.:Read Temp: <br /> Corrected Temp:Is corrected temp 4+12°C7 � Na** <br /> (Ac,mplance range for samples requiring thermal pres.) <br /> "Exception(If any): METALS / DFF ON iCE <br /> or Problem COC <br /> ►• "IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OV RESOLUTION. <br /> ' SRL Revision 7 <br /> I Replaces Rev 5(07113/04) Page of <br /> Effective 07/19/05 <br />