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SEQUOIA ANALY`11C.A,L SAMPLE RECEIPT LOG <br /> CLIENT NAME. DATE Received at Lab: (1115nluvg water)for <br /> REC.BY(PRINT) TIME Received at Lav: r] regulatory purposes: YESMO <br /> W0IUCORDEI1; 3 LOG 1N DATE: �, (Wastc►vater)for <br /> regalatoryPill 41otc9• YESINO <br /> CIRCLE T11E APPROPRIA'T'E RESPONSE LAB SAMPLE DATLO <br /> SAM 1,9# # CLIENT ID DESCRIPTION MATHSAM PL,D CONfJUION(ETC,) <br /> I Custody seat(s) res rtt I Absent VV z f <br /> Intgr4l Broken* <br /> `= 2 Ch, <br /> ut-oi-Custod 1!I Absent- <br /> 3 Traffic Reports or - fl <br /> Packing L[st Presmit I Aa <br /> z <br /> f 4 A[rU[lt Airbrlt 1 Sticker � <br /> b <br /> Ptesetkt 1 A e <br /> 5 Mbill# <br /> 4 G Sam lc Labels Gdllt I Absent <br /> 7 Sample IDs t d/Not Listed <br /> 4 otr I[attt-of-Cusfod i <br /> 8 Simple Condition 1t I Broken*I <br /> 4 Does nlforinat[on ol1 <br /> l <br /> custody lel[otls, traffic <br /> reporls and sample ; <br /> i labels a ree'� a No* <br /> s 10 Sample received within <br /> f 110111(1111p, e I No* <br /> 11 Proper Preservatives , <br /> used I No* <br /> k <br /> 1, I2 Temp Rec at Lab 4,0 <br /> (Accepta ace range for samples <br /> a t utr[[[ [Irer[[[[t1 res 4+1-20 Y I No* <br /> *II'Cir clect, contact Pt tet Maita er and attach recoa 1i of resolution. <br /> Sample Recelpf Log <br /> Revlalon 2 i(I MOM) <br /> - .,..�.�.�,. Page of <br />