Laserfiche WebLink
i J Ste` <br /> SEQUOIA ANALYTI(�AL SAMPLE RECEIPT LOG <br /> jCLIENT NAME• _ 3 Z- DATE RECD AT LA13 tie $L d� For Regulatory Purposes? ! <br /> IREC.BY(PFIiNi) TIME REC'D AT LAB: 0 DR11gKING WATER YES/Q§ r <br /> WORKORD7=R: Mb5 f jo DATE LOGGED IN: A-t! WASTE WATER YES lob <br /> !CIRCLE THE APPROPRIATE RESPONSE LAS DASH CLIENT 1D CONTAINER PRESERV SAMPLE DATE REMARKS: <br /> SAMIaLE# # MCRIPTION ATIVE pR MATRIX SAMPLED CONDITION(ETC) <br /> 1. Custody Seal(s) Prgsent/A It b MW - 4 — 1 a o <br /> 1 intact/Bmken* 6v - Z io f 057 <br /> 2 Chain-of-Custod nt 1 Absent* Au( q(o 15 <br /> 3 Traf#Io Reports or Lf it a <br /> Packing List: Present/ nt la ?t 015 <br /> 4.:Airbill. ro/Sucker n G <br /> I Pres nt/Absent 1 - 7 (al' <br /> 5 Airblll . t?I�o I o Q a w (a 5 3 Ia ?�t <br /> 9 Sam le Labels SI&W/Absent —Cl (o 1 °5 <br /> 7. Sample IQs /Not Listed r —10 w a3 <br /> on Chain-of-Custo —0 <br /> 8 Sample Condition- If&i/Broken*/ t2v <br /> Leaktn * t1 —2- <br /> 9. <br /> -Z8. Does information on chain-of-custody, 4 1 —3 10 � o <br /> 1 traffic reports and sample labels —`f 10(410.5 <br /> a ree? 5 (o 11 (0 5 <br /> 10 Sample received within —6 <br /> hold bme? /No* - `- <br /> 11 Adequate sample volume --DM W - i <br /> received? ya/No* <br /> 12 Pro er preservatives used? yap I No* 2' -3 tot b(a; <br /> 13 P10jank l Temp Blank Received? QCT VU+� ('i{ 1* 5 05 <br /> drde which if I No* <br /> 14. Read Temp <br /> Corrected Temp 5--7 4 �* <br /> is corrected temp 4+f 2"C? Y4R 1 No** <br /> (Amsplanco range for samples requlring thermal prey) <br /> *"Exception Of any). METALS / DFF OGI <br /> or Problem COC <br /> = - : i L <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OI'RESOLUTION <br /> SfiI.Rgvlslon 7 <br /> Replaces Rev 6(07113104) Page of <br />