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. SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> FREC. <br /> rNT NAME: DATE RECD AT LAB: d� For Regulatory Purposes? <br /> BY(PRINT) AhAtv ' TIME REC'D AT LAB: '3C DRINKING WATER YES/ <br /> RKORDER: 1 DATE LOGGEQ IN- WASTE WATER YES O <br /> (For clients requiring preservation checks at receipt,document here ) <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CLIENT ID CONTAINER PRESERV H SAMPLE DATE REMARKS- <br /> SAMPLE# # DESCRIPTION ATIVE P MATRIX SAMPLED CONDITION(ETC.) <br /> 1 Custody Seal(s) Present I y ff 733 V 0 �--� 7/1 VC1 <br /> Intact I Broken* 7l p r <br /> 2 Cham-of-Custod nt/Absent* 11A W5 <br /> 3,Traffic Reports or {i <br /> Packing Hsi Present/At� -7 <br /> 4 Airbill Airbill I StJcker ✓Yi bi1 <br /> Present I <br /> 5 Airbill# W—/O <br /> 6 Sample Labels /Absent <br /> 7 Sample IDs /Not Listed In/ -( I i 17 <br /> on Chaln-of-Custody -;I 7 d <br /> 8 Sample Condition. 4P&d/Broken*/ <br /> Leakin * EZ✓ 6' 7/1300't <br /> 9 Does tnformation on chain-of-custody, - o <br /> traffic reports and sample labels <br /> a ree? Yes IQO� L AGI <br /> 10 Sample received Wthin <br /> hold time, I No* <br /> 11 Adequate sample volume <br /> received? /No* <br /> 12 Proper Preservatives � ff <br /> used? 6G el No* <br /> 13 Trip Blank/Temp Blank Received? <br /> drele wMch,K Yes/ <br /> 14 Temp Rec at Lab <br /> Is temp 4+/-2°C? tea'/No** <br /> (Acceptance range for samples requiring thermal pres) <br /> *Exception(d any) METALS I DFF ON ICF: <br /> or Problem COC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION <br /> RL Revision 6 <br /> (t78W7WA) Page of <br /> ,dataces Rev 5 <br /> We 07/1=4 <br /> I <br />