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,t • <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> a <br /> CLIENT NAME: V ,S' DATE REG'D AT LAE: 7T6', II ._ <br /> RI:C.BY{Fitri4T) ,� 3rME REC'l3 aT SAB: 3�'�`'O For Regulatory Purposes? , <br /> DRINKINGWATER YESf Q <br /> : WQRKQI�DER: 63+20 DATE LOGGED IN. _ 17r aS� WASTE WATER YES 1 t <br /> { (For chants requiring pamervallon atrocks Ia%receipt,document h M <br /> CIRCLE THE APPROPRIATE RESPONSE LAD BASH CLIENT ID CONTAINEn PHESP-RVSAMPL€ DATE REMARKS: ; <br /> ' SAMPLE# f DEWHIPTION ATIVE PK MATflIX SAMPLED CONDITION(ETQ) <br /> 1 Cusimly Seal(i) Presant bsern' two—of <br /> i Intact/Broken' �` o I <br /> 2 chain-of-custodyse t f Abscnt' W <br /> 3. Tratfrc Reports or <br /> Packtn t�sl Present 1 utr <br /> 1 4.Alrbfll AKA11I Shaer <br /> II <br /> Present la4Genr I I <br /> 5 Airbrll ter .rte <br /> f3 Sample Labels &ROM I Absent l� f <br /> 7 Sample!Ds I Not Listed I� <br /> on Cha -of-Cuss II <br /> a Sample Condition nti cd/Draken'! I t <br /> Leakfrt ' <br /> 9 <br /> .. Does rnformatran on chain-of-custody, <br /> traffic sports and sample lab fal%;' <br /> e $ 1 11 <br /> 14 Sample receivad wM!n If <br /> hold brae) <br /> s <br /> I I-Adequato Sample volume <br /> tcoerved7 4ies I No. <br /> t2. Proper Preservatives <br /> used? 1 Nei II <br /> 13 Trip Blank/Temp Blank Receivedl I� <br /> (ctrclavAth.11y") Yost o'r' Il <br /> �4 Tamp Rec at Lab, <br /> 4s temp 4 t12°C? 4a I No" II ; <br /> JA=Pilarm rang&for sampbs regtfL"therrnw lues) <br /> '{E=epllon(if any) METALS / DFF ON ICE Il � <br /> .or Problem COC �� I <br /> *If CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECOFID OF RESOLUTION <br /> �i�i t#r+ris7we 6 ( 1 <br /> 3 Riav 5(orm'07M4) Page_ Du <br /> o07/ter a <br /> r <br /> Y <br />