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f <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT'LOG <br /> CLIENT NAME: i r DATE RECD AT'LAB: ( For Regulatory Purposes? <br /> �FrEc,BY(Pt31tV7� (r `Y 1 � TWE AEC'D'AT LAB: a DRIISKING WATER .YES 1 MG <br /> f`WORKORDER: FA--O 03'L" DATE LOGGED IN: WASTE WATER YES/NO <br /> a j <br /> CIRCLE THE APPROPRIATE RESPONSE LAH DASH CONTAINER PRESERV SAMPLE DATE,., REMARKS:1 CLIENT 1D. pH - <br /> SAMPLE# # DESCRIPTION ATIVE MATRIX SA PLED CONDITION(ETC.) r <br /> • t <br /> I.iCustody Seal(s) Present Abs <br /> Intact/Broken* <br /> 2. Chain-of-Custod rose /Absent* <br /> 3.iTraffic Reports or . <br /> Packing List: PcesentUAbsed <br /> I 4.;Airbill: Cret <br /> lrbSticker S{�_(I_(/Absent q J <br /> 5.-Airbill#: 2 <br /> 6, Sari le Labels: rese /Absent <br /> 17., ample IDs: is'ted/ d <br /> o hain-of-Cu <br /> B.Sample Condition. Broken*/ <br /> Leakin <br /> Fhold <br /> es information on chain-of-custody, 3 <br /> ffic reports and sample la :i <br /> ee? /No* . <br /> mple reeived within <br /> time? e /No* <br /> 11.Adeqpate sample volume <br /> received? <br /> d 12, Proper preservativ6s used? Ye)/-No- <br /> 13-Trip <br /> /No*13.Trip Blank/Temp Blank Heceived? <br /> a <br /> ,(circle which,if yes) Yes/No* <br /> a <br /> 14.-:Read Temp:- • <br /> g Corrected Temp: s v <br /> x <br /> Is corrected temp 4+1-2'C? e /No** <br /> (Accoptance range for samples requiring thermal Pres.) <br /> **Exception(if any): METALS / DFF ON ICE £ <br /> or Problem GOC <br /> i:�3R-�+'i1�7(s':%JF�yr r4+�..c F�.._`-.r -Z..r. _a. Ft aas.u )�i �F FSL +vltv�s< iT—^'. �:: .z�T- - 2kx_u'S.sY '•yn-,�T_ —•....ry - -?-2�r <br /> ti *IF CIRCLED, CONTACT PROJECT MANAGER AND ATTACH RECORD OE RESOLUTION.` Fl ` <br /> SRL Rovision 7 <br /> Replaces Hev 5(07/13/04) age—_of <br />