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' SEQUOIA ANALYTICAL SAMPLL R•ECEIPT'LOG <br /> 'Ci.kTNAME! [: DATE REVD AT'LAR: ( For Regulatory Purposes? <br /> IR=G,13Y(r-rif" �M ,' TIME RECID*AT LAB: � C� i)Rlr�[KfNG WATER .YES{90 <br /> IWORKQRDER: PA-9 03i DATE~LOGGED IN: WASTE WATER YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV SAMPLE DATE,., REMARKS: <br /> SAPLE# # CLIENT ID DESCRIPTION ATIVE pH <br /> MMATRIX SA A ED -CONDITION(ETC.) <br /> 1.iCustody Seal(s) Present Abs,nt512 ZM9fAt1C I Pke Z" <br /> Intact/Broken* <br /> 2. Chain-of-Custod • Fess /Absent* j PaS- <br /> 3.iTraffic Reports or -S ,. <br /> Packin List: Ptesent&AbsenD <br /> 4.;A1611' ' Airbi Sticker 5}"�—(1-C <br /> ! re /Absent _/ <br /> 5.'Airbill#: --------- <br /> s, Sem le Labels: rese /Absent <br /> 4 <br /> 7.-Sample iDs: fsted/ d <br /> o haln-of-Cu <br /> 8.Sample Condition: Broken*/ <br /> Leakln <br /> 9. •Does information an chain-of-custody, <br /> traffic reports and sample la <br /> a Fee? /No* <br /> 10. Sample received within <br /> hold time? e /No* a <br /> 11.Adequate sample volume <br /> received? /No* <br /> 12, Proper preservativ6s used? Ye /-No* <br /> 13-'Trip Blank/Temp Blank Received? <br /> �! <br /> (circle which,if es) Yes/N'o" <br /> 14. Read Temp: Ll <br /> - <br /> Corrected Temp: <br /> Is corrected temp 4 42°C? e /No** <br /> (Acceptance 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 OF RESOLUTION. <br /> SRL,,Revision 7 ( 4i <br /> 1 Annlacwa Rav S 107/19/nd1 PanO of <br />