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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIP.NT NAME. lks DATE Received at Lab: -10-0 (Diniltntg water) for <br /> REC BY(PRINT) TIME Recehed at Lab. 5-6-a regulatory purposes 'YESINo <br /> WORKORDER LOGIN DATE (Wastewater) for <br /> regidiitoi y purposes 'YESINO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION (ETC) <br /> I Custody Sell(s) es / t w— <br /> f <br /> Brokeg* <br /> 2 Chain-of-Custodyese t f Abseuvl <br /> 3 Traffic Reporls or <br /> Packiil&LisI Present/AQ( <br /> 4 Airbill Axrbill l Sticker <br /> Present I sen <br /> 5 Anbill# <br /> G Sample Labels t/Absent <br /> 7 Sample IDs is I Not Listed � <br /> on Cham-of Custod <br /> 8 Sample Condition to /Broken*/ <br /> ktn <br /> 9 Does mfonnatiou on <br /> custody reports, traffic # <br /> reports and sample <br /> labels a ree? !Na* <br /> 10 Sample received within <br /> hold time 6.�/No* <br /> lI Ptoper Preservatives 2C z <br /> used ^/No' <br /> i z. Temp W tit tab -h { <br /> 'Acceptance Eange for samples <br /> lu tilt Ing liter ttlnl Pres -4 t-1-2°t"} f el 1 No* <br /> WCircled-, contact Piect M-nna er and attach record of resolution. <br /> Sample rtPcefpe I og <br /> na i f Iiinrnm <br />