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{ <br /> J <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> 4 <br /> CLIEN I NADIL w Vt � DATE Received at Lab: (Drinking watei)for <br /> HI C.BY(PRINT) TIME Received at Lab, regulatory purposes• YLS1 <br /> 1'1'ORKOR.DER- LOG IN DATE.S I� <br /> �� (Wastewater)far <br /> regulatory purposes: YE5 <br /> 4 CIRCLE THE APPROPRIATE RESPONSE LAB Dash CONTAINER SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION pH MATRIX SAMPLED CONDITION (ETC.) <br /> C M101IN Seals) elt,,/ <br /> t/Absent <br /> Broken'" 35 <br /> 2 Cliaiu-of-Custod t/Absent* <br /> 3 Airbill ��Int <br /> II tic r <br /> i <br /> I Absent �� 1 <br /> 4 Airbill # ' <br /> 5 Sample Labelses it/Absent <br /> 0 Sample IDs s I Not Listed <br /> o_a Chaiii-of-Custod <br /> 7 Sample Condition 6-14t/Broken*/ <br /> Leaking* - <br /> 8 Dees 1nlot matron on custody reports, ` <br /> ttaltic repoi ts,and sample <br /> libels a rec.1 &/No* <br /> 9 Sample received witkun t <br /> bold lime /No* <br /> 10 PioperPrezer%atives <br /> used s I No* <br /> It Iem erature Blank Received? /No* <br /> 12 Temp Rec it Lab 3. de--c <br /> (Acccptan(-e targe fol samples <br /> i egmang tlieritial pres 4+l-2°C) s/No* <br /> I i Samples collected moic <br /> tliaii 4 days ago tl No <br /> *If Circled, contact Project Managei and attach record of resolution. <br /> Sample Receipt Log <br /> Revision?2(8130/04) Pag- of <br /> Replaces Revfston 2 1 (i 1110/00) FIGURE fib <br /> ( ilnrhvp 9/1/01 <br />