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r SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG ' <br /> CLIENT NAME: rc. DATE R> C'D A LAB �l t-loy - For Regiriatory Purposes?. ` <br /> RBC.BY(PRINT} �l•� `? TIME REC'D AT-LAB: �+�#� D.RINKiNG WATER <br /> WORKORDER• ,DG b�,4S _ DATELOGGED IN- <br /> WASTEWATER <br /> j (For clients requiring preservation checks at receipt,document here4} <br /> CIRCLET THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV SAMPLE DATE REMARKS: <br /> SAMPLE# CLIENT 1D • • DESCRIPTION ATIVE PH AVIATRIX SAMPLED CONDITION[ETC.) . <br /> 1. Custody Seals) Present l # IY 1 i� v� �-( --.' :' 4, 2 <br /> I Intac Broken' W <br /> •2 Chairrof-Gustod e /Absent` i • ' <br /> 3.Traffic Reports or a ..`( <br /> Packin test: Present/A e Of' <br /> 4.Alrbill: <br /> C�, �/Sttcicer — <br /> } "VJ t/Absent u�? <br /> 5.Airbill t Ola'f b a 12.E Z Ll f, <br /> B.Sample Labels: t/Absent r- <br /> 7.Sample 1Ds: Ld90/Not Listed id f� <br /> 'on Chaln-of-Custod it w12 <br /> 8.Sample Condition: 1 Brokenl <br /> L.eakln ' ' <br /> S. Does Information on ohaln-of-custody, C- <br /> tmffic reports and sample labels u° <br /> agree? !ke 7/n • <br /> 10,Sample recelved within ' <br /> ' hold time? we"s,1 N0* a V 3 'J 13 ' <br /> ,. 11.Adequate,sample volume l ` <br /> t received? e 1 No" 2G •-'L ! - <br /> t 12. Proper Preservatives C �/ <br /> f al Na' <br /> } u . <br /> 13.tnkOA 1 Temp Blank Retcefved? <br /> B whWN a /No' <br /> 14.Temp Rea.at Lab: <br /> Is 4emp 4 4-200? Yes I No** <br /> (Acoaptanca renpe,tor samples raGutdrtp ihsmtal pres.i - <br /> "Exceptloh('If any): METALS / DFF ON ICE <br /> or-Problem COC <br /> *1F CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION. <br /> .SFrt.Fievlslon 6 •- .. <br /> Page of <br /> Replaces Rev s(007104) --_- <br /> EifeatWe 07/1 e,4 <br />