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~J <br /> • IA ANALYTICALRAMPLE RECEIPT LOG <br /> SEQUOIA <br /> s � E <br /> CLIENT NAME DATE Received at Lab- � (Drinlong water)for <br /> REL. BY (PRINT) TIME Received at Lab- regulatory purposes: YES/NO <br /> `i'ORKORDEIt at1 fOt3°t LOG IN DATE• C9 17 <br /> aste%ater)for a <br /> regulatory purposes- YESINO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB Dash CONTAINER SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION pH MATRIX SAMPLED CONDITION(EIC.) ' <br /> v t>- <br /> 1 Custody Seal(s) r 1 Absent l <br /> t/Broken* <br /> W60%42-M4 2vm <br /> 2 Chata-ul-Cuslad ent/Absent* <br /> 3 Aubill Atrbiil I Sucher <br /> Present 1 Nftt <br /> F <br /> 4 Aarbcll# <br /> 5 Sample Labels t 1 Absent Y <br /> 6 Sample ID, d 1 Not Listed <br /> on Chain-of-Custody 'r <br /> 7 Sample Condition I rt /Broken*1 <br /> Leaking* <br /> 8 Does information on custody reports, <br /> tratfic reports,and sample <br /> labels a&M9 e 1 No* <br /> 9 Sample received within ; <br /> hold time �I No* If <br /> 10 Proper Preservaures <br /> used I No* <br /> 11 I ein erature Blank Received? ff4 1 No* <br /> 12 Temp Rec at Lab degrees c <br /> S <br /> (ACLeptance range for samples <br /> leguiring thernta!Pies 4+I-2°C) e /No* <br /> 13 Saniples collected snore <br /> than 4 days a o'l Yes*1 iD <br /> M111 Ik <br /> *If Circled,contact Project Manager and attach recoi d of resolution. <br /> Sample Receipt Log <br /> Revision 2 2(8130!04) Page of <br /> Replaces Revision 2 1 (11/10100) FIGURE 6b <br /> Clfedive 9/1!04 <br />