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SEQUOIA ANALYTICAL SAMPLE RECEIPT-LOG <br /> CLIENT NAME'. wO R5 = DATE REC'D AT'LAB: 11 _ For Regulatory Purposes? x� <br /> �riec.sY p't3in rl (M� i!' TIME I?EC'D'AT LAB: �t DRINKINGWATER -YESMO <br /> t30 <br /> jWORKORDER: pA a'0 DATE LOGGED IN: �'I O� WASTE WATER YES/NO <br /> s <br /> �ClRCLE THE APPROPRIATE RESPONSE LAB BASH CLIENT ID. CONTAINER PRESERV pH SAMPLE DATE... REMARKS: <br /> SAMPLE# # DESCRIPTION ATIVE MATRIX SAMP ED -CONDITION(ETC.) <br /> i 1.;Custody Seals) Present Absent D I R-f� p— ! <br /> Intact/Broken* <br /> 2. Chain-of-Custod rose /Absent* <br /> 3.Traffic Reports or <br /> Packing List: P sent bsen <br /> I 4.;Aifiill: Airbi Sticker <br /> � 1 <br /> res /Absent <br /> 5.'Airbiil 2c j <br /> 6. Sample Labels: rese !Absent g <br /> 7.;Sample IDs: Listed/ ed <br /> o hain-of-Cu <br /> 9.Sample Condition: Broken*/ <br /> Leakin <br /> 9. -Does information on chain-of-custody, <br /> traffic reports and sample la <br /> agree? /No* <br /> 14. Sample received within <br /> hold time? <br /> 11. Adequate sample volume -' <br /> received? /No* <br /> 1.2, Proper preservativos used? Ye /'No* <br /> 13.,Trip Blank/Temp Blank Received? <br /> !(circle which,if es) Yes/No* <br /> t 14. Read Temp:• 1 3 ; - <br /> Corrected Temp: S .3 - . <br /> Is corrected temp 4+/-2°C? (2�/No** <br /> 211 <br /> (Acc©piance 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 FIECORD OF RESOLUTION. <br /> SRL Revislon 7 <br /> Replaces Rev 5(07113/04) Page of <br />