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r <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: DATE Received at Lab; (Drinlung water)for <br /> REC. BY (PRINT) TIME Received at Lab: , regulatory purposes: YESINO <br /> } WORKORDER. LOG IN DATE: (Wastewater)for <br /> regulatory purposes: YESINO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC.) <br /> I Custody Seal(s) Present! bsen � >� �� -? •� <br /> a <br /> Intact 1 B en* zy <br /> 2 Cham-of-Custad re t/Absent* - <br /> `t <br /> 3 Traffic.Reports or -4 ' 1/ <br /> Packing List Present 1 b t <br /> 4 Airbill Anrbw!SZnt) <br /> Present 1 <br /> 5 Airbill# <br /> 6 Sample Labels r t/Absent <br /> 7 Sample IDs1 Not Listed <br /> o Chain-of Cu5tod <br /> 8 Sample Condition nta /Broken*! <br /> U:1*n * <br /> 9 Does information on <br /> custody reports,traffic z <br /> reports and sasnple <br /> labels agree? eQ1 No* <br /> 10 Sample received wrtlun <br /> ` hold tine I No* <br /> 11 Proper Preservatives <br /> usedY s 1 No* <br /> 12 Temp Ree at Lab <br /> s <br /> r <br /> (Acceptance range for samples <br /> F <br /> rEquiring thermal Eres. 4+/-2°C) az1 No* <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log 4 <br /> Revlsmn 21 (11/1o/O0) <br /> Replaces Revism 2(11/06100) Page of <br /> crr .+. I r n3mn <br />