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I <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME. S DATE Received at Lab: - (1)r7nlung water) Nr <br /> REC BY{PRINT} TIAIE Recertied at Lala: regulatory purposes, YESINo <br /> WORKORDER. LOG IN DATE. 3— (Wastewater) for <br /> regulator y primroses- YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC) <br /> I Custody Seal(s) I Absent 1 <br /> yy <br /> I Broken* <br /> 2 Clialli-of-Custodynese t I Absent* <br /> 3 Traffic Reports or <br /> Pacltirn Lrsl Present Abs ' <br /> h Arrbrll Airbill/ Sticker <br /> Present fl�rse t <br /> 5 Aubill 4 <br /> 6 Sample Labels re nt/Absent ] <br /> 7 Sample l©s st 1 Not Listed <br /> en Chain-of Custod <br /> 8 Sample Condition 1 itac /l3rgkert*/ <br /> Leakrn * <br /> 9 Does rnfonnation on - <br /> ctrslody reports, traffic <br /> reports and sample <br /> libels a peed as I No* <br /> 0 Sample received wide t z � <br /> hold Wile ,211 Na* <br /> I Ptoper Pieservatives <br /> used es/No" <br /> [Z, Rinp Kec a[Lab 5 <br /> f <br /> Accepinnce lenge fnr samples <br /> [C(11111,1113 lltei mil pies -411-2°C) es No* <br /> N_wifh.__.xr:n_}?rs____.___._ I .mw -.,�1� r H- +a F+" nYd k., r � v.. arc✓ ,m. W r . s. � t <br /> *lf Cis c[ecl, coiltact Pl oject NIS r an h record of resolution. <br /> Sample Receipt I og <br /> 0.-1 ' 1rltnnlml <br />