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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: DATE Received at Lab: --� n„�� (Drinking water)foe <br /> REC.BY (PRINT) TIME Received at Lab: regulatory purposes: YES/NO <br /> F <br /> WORKORDER. LOG IN DATE: — "� (Wastewater)for � <br /> a <br /> regulatory purposes: YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC.) <br /> 1 Custody Seal(s) Present 1 A nt V ..C) <br /> Intact 1 n* Z <br /> 2 Cltarn-of-custodyres t/Absent* <br /> 3 Tiaffic Reports or <br /> Packing List Present 4bst <br /> 4 Airbril, Atrbill/Sticker �V <br /> Present/Lb6p 9V <br /> 5 Atibill4 1 i2 <br /> 6 Sample Labels rese t/Absent f } <br /> 7 Sample IDs VSd/Not Listed U � <br /> on 11aln-of-Custod v <br /> 9 <br /> 8 Sample Condition nt t/Broken*/ tX5 <br /> LealuII <br /> 9 Does information on <br /> custody reports, traffic Y <br /> 4 reports and sample <br /> labels a reel Y 1 Nn* rV <br /> 10 Sample received within W Z.- <br /> bold time s/No <br /> 11 Proper Preservatives <br /> R used Y /No* <br /> 12 Temp Rec at Lab �o <br /> (Acceptance range for samples '7 -� <br /> re uir�n thetma! eres 44/-2°C) ye /No* <br /> *If Circled, contact Pra'ect Manager and attach,record of resolution. <br /> Sample Receipt Log <br /> Revision 21 (1Ill 0100) , <br /> - - _ Page of <br />