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3- <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT-LOG <br /> CLIENT.NQIUCE� i i` DATE RLC'D AT•LAR: { For Regulatory Purposes? <br /> fRr:o. Eyy(rRtN-q 7iME REC'Dwr LAB: 1 C� DRINKING WATER -YES/riC' <br /> {'WONKORDER: l'1�1� 3 DATE LOGGED 1N: / WASTE WATER YES l y <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV SAMPLE DATE•., REMARKS: <br /> SAMPLE# # CLIENT ID• DESC IPTION ATIVE PH MATRIX SAMP ED -CONDITION(ETC.) <br /> 1.ICustody Seal(s) Prgsent Abs nt a/ 0 L <br /> Intact/Broken* d Z <br /> 2. Chain-of-Custod rase /Absent* i <br /> 3.iTraffic Reports or <br /> Packing List: PwsentKAbsen o� <br /> �.',Airbill' Airbi Sticker t. <br /> 1 re /Absent bfi <br /> 5.-Airbill#: <br /> 6. Sample Labels: rose /Absent o <br /> 7.-Sample IDs: Listed/ d " <br /> - o hain-of-Cu <br /> 8_Sample Condition: CWLio <br /> Broken*/ <br /> (" <br /> Leaking" } <br /> 9. Does information on chain-of-custody, <br /> traffic reports and sample la <br /> agree? - /No* <br /> 10. Sample ruceived within <br /> hold time? e /No* , <br /> 11.Adequate sample volume a <br /> received? /No* <br /> 12, Proper preservativos used? Ye f No* <br /> 13_Trip Blank/Temp Blank Received? <br /> '(circle which,if yes) r Yes rNb x <br /> (14.:Read Temp: <br /> Corrected Temp: <br /> Is corrected temp 4+/-2°C? ss No** <br /> (Acceptance tango for samples requiring thermal pros.) <br /> p**Exception (if any): METALS / DFF ON ICE <br /> or Problem COC a <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION., <br /> SRI.Revislon 7 { t <br /> 3 Replaces Rev 5(07/13/04) Page of <br />