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SEQUOIA ANALYTICAL SAMPLE RECEIPT-LOG <br /> CLIENT.NAME! ,5 DATE REVD AT LAB: For Regulatory Purposes? , <br /> R� r'.Dy T-FIIN /� TIME Rr_CD'AT LAB:__ J DRINKING WATER .YES f o <br /> WDRKORDER: M pA b f 37- DATE LOGGED IN; - — �' WASTE WATER YES/10 y. <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV SAMPLE DATE,., REMARKS: 1 <br /> 1 CLIENT Ib. pH <br /> SAMPLE# # DE5C IP710N AT[VE MATRIX SAMP ED CONDITION{ETC.) :. <br /> t <br /> i 1..Custody Seal{s) Present Ahs nt �/ Q t <br /> Intact/Broken* e Z <br /> 2, Chain-of-Custod rase /Absent* <br /> 3.iTraffic Reports or 9 <br /> Packing List: P sent bsen o( <br /> i 4.Airbiil: - Airbi Sticker � � .� <br /> re /Absent b 1 <br /> 5."Airbill#: (C072-E2'qqj <br /> 6, Sam Ie Labels: r�f_reseN/Absent 01 . �/ <br /> 7.- ample IDs: Listed/ d <br /> . • o hain-of-Cu <br /> B.Sample Condition: Broken*/ <br /> Leakin t F <br /> 9. .Does information on chain-of-custody, <br /> traffic Deports and sample la <br /> ..a ree? /No* <br /> I 0. Sample received within <br /> hold time? e /tJo* <br /> 11.Adequate sample volume <br /> received? <br /> 1.2, Proper preservatives used? Ye /No* <br /> 13.Trip Blank/Temp Blank Received? <br /> (circle which,if yes) Yes/No* <br /> 14.;Read Temp: D'jD <br /> Corrected Temp: <br /> Is corrected temp 4+/-2°C? Qs No"* s <br /> (Acceptance range for samples requiring thermal pres.) <br /> *'Exception(if any): METALS / DFF ON ICE <br /> or Problem COC <br /> kta f - <br /> x *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OP RESOLUTION. <br /> SRL.Rovlaton 7 ( t <br /> I Replaces Rev 5(07/13/04) Page of <br />