Laserfiche WebLink
SEQUOIA ANALYTICAL SAMPLE RECEIPT'LOG <br /> +CLIENT NAME: (J� _ DATE R_EC'D AT LAB: 1 For Regulatory Purposes? Y <br /> f ;REC. BY(PRINT) <br /> (M� TIME REC D'AT LAB: DRIN-KING WATER YES/i� <br /> VORKORDER: G <br /> /� ��/ DATE LOGGED IN: WASTE WATER Y1S <br /> jCIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV H SAMPLE DATE.-- REMARKS: I <br /> CLIENT ID- p <br /> SAMPLE_# # DESCRIPTION ATIVE MATRIX SAMPLED -CONDITION(ETC.) t <br /> t <br /> 1.iCustody Seal(s) Present Absent ! *j Cie s b� <br /> Intact/Broken* 71- q_13/ -ILS <br /> 2. Chain-of-Custody nese /Absent* v . <br /> 3.iTraffic Reports orI <br /> Packin List: P sent KAbsenD <br /> 4.;Airbillf Airbi Sticker <br /> res /Absent - <br /> 5.-Airbill 1f: I C077 'Z "5 <br /> s. Sam le Labels: rose I Absent <br /> 7.,Sample IDs: fisted/ ed <br /> o pain-of-Cu <br /> a B-;Sample Condition: Broken*/ <br /> I' Leakin - - <br /> g 9. Does information on chain-of-custody, <br /> traffic reports and sample la <br /> a ree? - /No* K <br /> 5 ' <br /> 10. Sample received within ?t <br /> hold time? e /No* <br /> 11, Adequate sample volume <br /> r <br /> received? /No* <br /> 12, Pro or roservatives used? Ye /No* d <br /> a 13.;Trip Blank/Temp Blank Received? <br /> (circle which,it yes) Yes rNo* <br /> Fj 14. Read Temp: <br /> � Corrected Temp: <br /> Is corrected temp 4+/-2°C? /No** <br /> (Acceptance range for samples requiring thermal pres-) <br /> **Exception (if any): METALS / DFF ON ICE <br /> or Probl6m COC <br /> N' v r" � _ P fir. _� - 4AGolfAS'F1P4=' ..\ '•' • J-•• .Y T - a }' <br /> x *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION. <br /> I SRL Revision 7 I ` <br /> 4 Replaces Rev 5(07/13/04) Pann nt <br />