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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> 'J <br /> 3 CLIENT NAME: VA DATE RECD AT LAB: For flegulatory Purposes? <br /> AEC_BY(PRINT) W.) TIME REC'D AT LAB: 3=.to DRINKING WATER YESIQ i <br /> 3 WORKORDER: b34-P DATE LOGGED IN. WASTE WATER YES 1s <br /> { i (For chants requidng prm <br /> oservRilen chocksal reeespt,docuent hero <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESF..fi11 pH S"PLE BATE �{ <br /> SAMPL- A CLIENT ID I]ESCRIPTION ATLYE f1EMAIiKS: <br /> MATRIX <br /> $ltfIIIPLEI? GDNDlTiON{ETC) <br /> I Custody Sears) Present bssarlt' r lit"' 3} � LG .� �- ' I$16 f <br /> Intact/Broken' s <br /> 2 Chain-of-Custody t##lbsont' SSIV--7 <br /> 3 Traffic Reports or ; <br /> Paclun2 List PFGSent#Al i—d- <br /> d.Alibfff Afrbifl l Sticker <br /> a Present fa�sQrnv <br /> S Airbsll9 <br /> ii Sample Labols re 1#Absent f <br /> 7 Sample IDs d 1 Not fisted <br /> on Chain-of-Cust <br /> i <br /> 8 Sample Gondstian ntaef 1 Broken'/ IL <br /> ; <br /> Leaklrt ` < <br /> 9. Does information an chain-of-custody, - s <br /> traffic fOportS and sample lab is ,f,;moo t <br /> agree? <Mf <br /> 10 Sample received Wthin <br /> hold time9 #No' <br /> 11.Adequate sample volume <br /> received? s#No. - <br /> 12 Proper Preservatives <br /> used? I Na+ <br /> 13 Trip BlankITeinp Blank Recesved7 <br /> (drrJa vAlkh.if y") Yos Aqp z l <br /> 14 Tamp Ree at Lab. ; "C l <br /> Is temp 4+,f-2°C? 4&11 No" 4 <br /> (Ameplanoe range for s[unpins regifiring thermal Ores) 1 <br /> 4'Exceplfoa(rt any) METALS ! DFF ON ICE <br /> or Problem COCAim <br /> } <br /> 3 <br /> i <br /> IF CIRCLE=D,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION <br /> AI.fteri5 M 6 <br /> a 4711 5{Qfx'07104} . ` e <br /> 097113M4 Page—*. <br /> Y <br />