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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> . .... ..... <br /> CLIENT NAME: DATE Received at Lab: (Drinking water)for <br /> REC. BY(PRINT) C1/ TIME Received at Lab: 10 regulatory purposes. YESINO <br /> ms <br /> WORKORDER: 4015 2-a LOG IN DATE' V (Wastewater) for <br /> regulatory purposes: YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLEDCONDITION (E <br /> 1. Custody Seal(s) went Absent M$Ij <br /> VN <br /> I Broken* <br /> (Pr <br /> 2. Chain-of-Custody (r e/s q %4 e-1 <br /> Absent* r1i- <br /> 3. Traffic Reports or 5r2e b j_70-e-j <br /> j PV L161 EL <br /> Packing List: Pre nt nbsc)n -------- <br /> 4, Airbill: 01N kciz;r <br /> kresept/Absent <br /> 5. Airbill 4:1z CoZ3D3 l2 7!yC) <br /> 6. Sample Labels: esea/Absent <br /> 7. Sample IDs: X��is�tl Not Listed <br /> on Chain-of-CusLody <br /> 8. Sample Condition: 1@5t Broken-I <br /> Leaking* <br /> 9.'Docs information on <br /> j <br /> custody reports, traffic <br /> reports and sample <br /> labels agree? 1 No- <br /> 10. Sample received within <br /> ne <br /> - <br /> Bold tine: No' <br /> 11. Proper Preservatives <br /> used: <br /> 12. Temp Rec. at Lab' <br /> (Acceptance range for samples <br /> Ing therms Pres.:4+1-21C) Yes I <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revision2.1 (11110/00) Page of <br /> ReDIBUS Revision 2(111061001 <br />