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SEQUOIA ANALYTICAL. SAMPLE RECEIPT LOG <br /> CLIENT NAME: (bP T14Sc ' DATE RECD AT LAD: For Regulatory Purposes? <br /> REC.BY(PRINT) tw TIME REC'D AT LAB: Soo DRINKING WATER Y <br /> WORKOF3DER: _ ^_ alb _f� DATE LOGGED IN: -- -" Y WASTE WATER l <br /> (Por clients requiring preservation checks at receipt,document herd ) <br /> CIRCLE THE APPROPRIATE RESPONSE LAR AASH CLIENT ID CONTAINER PRESERV H SAMPLE DATE . REMARKS: <br /> SAMPLE# # DESCRIPTION A71VE P MATRIX SAMPLED CONDITION(ETC.) . <br /> 1. Custody Seal(s) CPr t/Absent a' -2 — LqEttE <br /> Utaa /Beoken* rri <br /> 2. Chain-of-Custody .re . /Absent* y3 <br /> 3.Traffic Reports or. S'A15010saS?.=C <br /> Packin List: 9 /Absent <br /> 4. Airbill: .�i I 1 Sticker <br /> Pres Absent <br /> 5. Airbill#: WOVDT i(OR 2gPI I <br /> 6. Sample Labels: resent/Absent <br /> 7. Sample IDs: /Not Listen <br /> on Chain-of-Custody <br /> 8. Sample Condition: nt""' /Broken*1 <br /> Leal in <br /> 9. Does information on chain-of-custody, <br /> traffic reports and sample labels <br /> agree? a No* <br /> 10. Sample received within <br /> hold time? /No* <br /> 11.Adequate sample volume IV <br /> received? I No* <br /> 12. Proper preservatives <br /> used? e /No* <br /> 13.T p Blan` �k Received? <br /> circle Mich.I1 es) /No* <br /> 14.Temp Rec. at Lab: -eZ q% <br /> Is temp 4+/-2°C? e /NO** <br /> (Aemptanos range for samples requiring thermal pres.) , ' <br /> -Exception (if any): METALS 1 DFF ON ICE <br /> or Problem COC0. d. <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION. <br /> SRL Revision 6 Page of <br /> 'Replaces fiev 5(061(Y7104) <br /> Efleclive 07/13M <br />