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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG X <br /> y A kY <br /> CLIEN I NAME. f� , <br /> DATE Received at Lab (Drinking water)for ' <br /> REC.BY (PRINT) TIME Receiver]at Lab- regulatory purposes. YES/NO <br /> LOG IN DATE: i ) _ (Wastewater)for <br /> ORKORDER: — <br /> �' regulatory purposes: YESfNO <br /> iCONTAINER SAMPLE DATE <br /> CIRCLE THE APPROPRIATE RESPONSE LAB Dash <br /> SAMPLE# # CLIENT ID DESCRIPTION pH MATRIX SAMPLED CONDITION(ETC.) <br /> C 1 Custody Seal(s) .ie nt 1 <br /> n t I Broken* ✓7_ 4 '' � 1/'V Jr <br /> 2 Chain-of-Custod t I A nt* <br /> 3 Airbill Airbilll tLeiker <br /> t <br /> ' e nt l Absent <br /> -' 4 Airbill# ; <br /> s S Sam 1e Labels es t 1 Absent <br /> 6 Sample IDs 6kd/Not Listed NNII <br /> on Chain-of-Custody <br /> 7 Sample Condittoti r1n4t 1 Brokent 1 <br /> s • Lealun * <br /> fi <br /> 8 Does information on custody reports, <br /> traffic reports,and sample <br /> labels agree? I No* r <br /> 9 Sample received wtthttt <br /> hold time 1 No* <br /> ' 10 Proper Preservatives <br /> ' used Qs I No's t <br /> t <br /> 11 3 ern nature 131ank Received? s 1 No* <br /> F <br /> 12 Temp Rec at Lab r > c <br /> (Acceptance range for samples € <br /> re uirtnQ ttictmal pies 4+1-2°C) QS I No* <br /> 13 Samples coller.ted titore <br /> than 4 da s ago? Yes*1 <br /> r a i ,, ,, o r _ m _ u r <br /> *If Circled, contact Project Manages and attach record of resolution. <br /> Sample Receipt Log <br /> Rev"2(8130104) Pale <br /> Re Revision 21 (11110100) F&E 6ift M M M <br />