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SEQUOIA ANALYTICAL SAMPLE RECEIPT'LOG <br /> CLI ENIT.NAME! (1t 1� �,� DATE RECD AYLA13: ( For Regulatory PurpJ(E <br /> trEG.DY(PRIrY� d `Y r 'TIME REO'D'AT LAB: a DRINKINGWATER WQRKORDEF3: DATE LOGGED (N: WASTE WATER GIfiCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV SAMPLE DATE,.. RESAMPLE# # CL1EN71D• DESCRIPTION ATIVE pHMATRIX SA PLED -CONDI1. Custody Seals) Present Abs nt —� 2 Zln n CO Z" <br /> j Intact/Broken* <br /> { 2. Chain rase /Absent* 517 's- <br /> S.rTraffic Reports or ,. <br /> Packing Ust: P sent bsen 5 -1� <br /> 4.;Airbill' Airbi Sticker C <br /> 1 re /Absent <br /> 5. Airbill#: <br /> 2- <br /> 6. Sample Labels: rese /Absent <br /> 7.;Sample IDs: fisted/ItAUsWd <br /> o hain-of-Curtod <br /> B..Sample Condition Broken*/ <br /> Leaking' <br /> 9. -Does information on chain-of-custody, <br /> fratfio reports and sample la <br /> ..a ree? "/No} ILA 1� <br /> 10. Sample recelved within LL <br /> hold time? e /No* <br /> 11._Adequate sample volume <br /> ` received? 1 No* <br /> k <br /> 1.2, Proper preservatives used? Ye /No* <br /> 13.Trip Slank/Temp Blank Received? <br /> (circle which,if yes) Yes!wo- <br /> 14.'Read Temp: <br /> I Corrected Temp: !j <br /> Is corrected temp 4+/-2°C? e /No"* <br /> (Acceptance range for samples requiring thermal prm.) <br /> "Exception(if any): METALS / DFF ON ICE <br /> or Problem COC <br /> ' ^u. •. <br /> *1F CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION. T <br /> SRL.Revislon7 <br /> Replaces Rev 5(07/13/04) Pago of <br />