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- SEQUOIA ANALYTICAL SAMPLE RECEIPT LOO <br /> FREC.BY(PRINT) <br /> NT NAME DATE REC'DATLAB: 7 L&1_ For Regulatory Purposes? <br /> 2' TIME RECD AT LAB. '�C DRINKING WATER Y.ES IRKORDER: a,>3 7- 1 DATE LOGGED IN. _ "�� WASTE WATER YES 0 <br /> (For ciients requiring preservation checks at receipt,document here ) <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CLIENT ID CONTAINER PRESERV pH SAMPLE DATE REMARKS. <br /> SAMPLE# # DESCRIPTION ATIVE MATRIX SAMPLED CONDITION(ETC.) <br /> 1 Custody Seal(s) Present I A�Pf , p �.. F� t <br /> 71 <br /> Intact/Broken* _ 7l a r <br /> 2 Chain-of-Custod nt/Absent* <br /> 3. Traffic Reports or .�. <br /> Packing IJst Present <br /> 4 Airbill. Airbill/Skker <br /> Present/AIgv - <br /> 5 Airbiq# u/-f p <br /> 6 Sample Labels /Absent <br /> 7 Sample IDs /Not Listed l„/ - O1. <br /> on Chain-of-Custodyd4C <br /> 8 Sample Condition 9figaet/Broken* <br /> Leaking* CIA/^6' 7/l c)-t <br /> 9 Does information on chain-of-custody, 771 f <br /> traffic reports and sample labels -x2 <br /> agree? Yes lgo� G A U/--3 <br /> 10 Sample received within <br /> hold times !No* <br /> 11 Adequate sample volume <br /> received? /No* <br /> 12 Proper Preservatives JI <br /> used? &4'1 No* IL <br /> [*Exception <br /> 3 Trip Blank/Tamp Blank Received? <br /> circle which. Yes/ <br /> 4 Temp Rec at Lab <br /> Is temp 4+1-20C? tae'/No** <br /> Aceepiance range for samples requiring thermal pros) <br /> (if any) METALS 1 DFF ON ICE <br /> or Problem COC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION. <br /> RL Revision 6 ` <br /> jiftes Rev 5(06/47104) Page t <br /> e 07113!44 0 <br />