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SEQUOIA ANALYTICAL SAWLE RECEITT LOG <br /> CLMNT NAM&: DATE Received at Lab: l A irinkingwater for <br /> REC.BY(PRIN TIME Received at Lely: 3 r lefory puRms": YESIc IYOBRORDERt ?� { C� LOG IN DATE; y Wastewater far <br /> regulafory purposes: YFS <br /> CIRCLE THEAPPROPI ATEMPONS� LAB CONTAINER SA141p1,$ DATE REAIARI{�S: <br /> G <br /> SAMPLE# A CLIENT ID D p ON MATRIX SAMPLED CONDITION <br /> 1. 46dy Seat(s) pruent Atis�nt <br /> ` Intim[f Broken* <br /> 2. Chain-of Cuslod r Abscnt'- <br /> ` 3.Traffic Rcporls or <br /> Paeldug List Present nl <br /> 4 Arrtrill Arrbill l Sttc er <br /> Presc�tl! n - <br /> 5 Anbill## <br /> 6 Saot le Labels Pces I Absent <br /> 7. Sample WS, est Not Lrsted ; <br /> n-nf•Custad <br /> 8 Sample Condiatin Intact roken*/ <br /> 91 Docs tufornrairon on <br /> crostody reports,traMr, <br /> rerporfs and sample <br /> $ labols a rcc? es Ne <br /> 10 Samplo r=Lved wj Min <br /> i hold time Na" <br /> f 11. ProperPreserWives <br /> used, !No's <br /> 12 Tcatp Rcc at Lab, C <br /> fs(emp 4+1-2°C'7 �uDNOR <br /> (Accepiaocc range for samples re}quir�m the al preys-) <br /> R*Exception(if any).MetalsIDPI?no ice? <br /> oc Probkent COC �l7 on ice <br /> Sunp4 RaMpt tog 4 'It Circled Contact Project Afa0ager and attach record Of res ohitIon. <br /> Re*Ton 23(IM11 2) _ <br /> Replaces Revislan 21 (Wl IM) Page of <br /> Effecthm 12R4M <br />