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0 <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME- 1 t `1 DATE RECD AT LAB- M'-UFor Regulatok <br /> REC.BY(PRINT) �+o TIME REC'D AT LAS: 911- DRINKING WAT <br /> WORKORDER• b� 64! DATE LOGGED IN: 5 /��6s WASTE WATER <br /> - (For clients requiring preservation checks at recelpt,document here�) <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERv SAMPLE DATE REMARKS; <br /> SAMPLE# tE CLIENT 1D DESCRIPTION ATIVE PH MATRIX SAMPLED CONDITION(ETC) <br /> 1 Custody Seal(s) P're t 1 Absent <br /> �.�,+-� W1:1 'lP i•UCSL W t5f 1111 <br /> tact Broken* <br /> 2, Chain-of-Custody resen Absent* <br /> 3 Traffic Reports or 4 <br /> Packing List re /Absent ill"it Or511IL" <br /> 4 Alrbiltbi I 1 Sticker <br /> Prose Absent <br /> 5 Airbiil#• <br /> S Sam le Labels re nt 1 Absent <br /> 7 Sample IDsCis 1 Not Listed <br /> on Chain- <br /> of-Custody-8 Sample Condition nta Broken*/ <br /> Leaking* <br /> 9 Does information on chain-of-custody, <br /> traffic reports and sample labels <br /> s ree? es/No- <br /> 10 Sample received within <br /> hold time? a No* <br /> 11 Adequate sample volume <br /> received I No* <br /> 12 Proper Preservatives <br /> used9 s/No" <br /> 13rip 81 em a deceived? <br /> L' L <br /> ,if es e 1 NV <br /> c at Lab �2_°r- <br /> 4+1-2°C? /IVa"nge for samples requiring thermal pros)(if any} METALS 1 DFF ON ICEem COC maw <br /> -IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION <br /> SRL Revision B Page of <br /> Replaces Rev 5(06J07104) <br /> r.......l. rc►11141Aa <br />