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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENTNAME' DATE RECD AT•LAB: ( For Regulatory Purposes? r <br /> �ftcu. fsY(PHrrv-Q _ (/ `Y r TIME REC'D'AT LAs: ' � DRINKING WATER -Y>_Sf fl <br /> 'WORKORDER; Nj pL1 b l•�f DATE LOGGED IN: 1 WASTE WATER YE NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV pH SAMPLE DATE,., REMARKS: <br /> e ! SAMPLE ff # CLIENT ID• DESCRIPTION ATIVE MATRIX SA P _D -CONDITION(ETC.) <br /> t <br /> i.lCustody Seals) Present Abs nt _(-7 LOT- <br /> intact ( 7 D5 <br /> /Broken' vl/ -b f <br /> 2. Chain-of-Custody rese /Absont* v3 Z• . r <br /> ' 3.i Fraffic Reports or <br /> Packing List: P sent bsen b l)T <br /> 4.!Airbill' Airbi Sticker �yTDT -ct 51/z V1l . J <br /> re pt/Absent <br /> 5.'Airbill#: q <br /> �. 6, Sample Labels: rose /Absent <br /> s 7.,Sample IDs: fisted/ d i <br /> o haln-of-Cu <br /> B. Sample Condition: Broken*/ <br /> Leakin <br /> 9. .Does information on chain-of-custody, <br /> traffic Deports and sample la1 110 <br /> a roe? /No* s. <br /> 10. Sample received within <br /> hold time? e /No* <br /> 11.Adequate sample volume <br /> received? /No* <br /> 1.2, Proper preservafivos used? Ye !'No* <br /> £13.Trip Blank/Temp Blank Received? <br /> i(circle which,if es) Yes f—No- <br /> 14. Rea <br /> o*14.:Read Ternp: j <br /> Corrected Temp: . <br /> Is corrected temp 4+/-2°C?r <br /> es/Noy* <br /> (Acceptance range for samples requiring thermal prey.) <br /> "Exception(if any): METALS / DFF ON ICE <br /> or. Problem COC ` <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION. <br /> s SRI.Revision 7 - t <br /> 1_Replaces Rev 5(07113/04) Page " of <br />