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it <br /> i <br /> SEQUOIA.ANALYTICAL SAMPLE RECEIPT LUG <br /> CLIEN t NAME- DATE Received at Lob (Cij�`y �G'�f- (Drinking vvatet)for <br /> ItF C; 13Y (PRINT) . TIME Received at Lab- regulatory purposes- It <br /> WORKORDL+R. Q Z�� LOG IN DATE: (Wnstewnter)for <br /> rets+vtatory purposes- Y ESfNO <br /> CIRCLE'l HE APPROPRIA TE RESPONSE LAB Dash CONTAINER SAMPLE DAZE <br /> SAMPLE if # CLIENT ID DESCRIPTION pII NIATRLY SAMPLED ° 11,WTION(EIC) <br /> l CubtodySeal(s) Ptesent/A410 -� Z <br /> intact 1 Broken* ~ L/ <br /> 2 Chain-of-Custudy e /Absent* <br /> 3 An bill Airbill/Sticker <br /> Present/ se <br /> 4 ATrbitl!i <br /> _L_S lc Labels r se t/Absent <br /> G Sample IDs ist /Not Listed <br /> o haw-of-Custody <br /> 7 Sample Conditioli 6i*it/Broken*/ <br /> Leaking* <br /> 8 Does inforindtiOn on custody reports, <br /> traffic reports,and sample i <br /> labels a tee? /No* <br /> 9 Sample received within <br /> hold Lillie Y /No* <br /> 10 Proper Dieser vatWes <br /> used nes/No* <br /> 11 lent erattire Blank Received? al No* <br /> 12 Tcrnp Rec at Lab drg,rc.C <br /> (Acceptance range for samples 11 <br /> Inwriog therutai pies 4+/-2°C) s I No's <br /> 13 Samples collected itioie <br /> Thai►a da s ago l Yes <br /> !f <br /> Samt+t sEN Cog <br /> Circled, contact Pt uj lt <br /> Saa ei and attarb t ecot dof A esolUllott <br /> tlevl , (8130104? qw <br /> P <br /> Rnn1^t es i invi^Ion 2 1 I1 1!lUlUaget)} -- <br />