Laserfiche WebLink
SEQUOIA ANALYTICAL SAMPLE RECEIPT.LOG <br /> 1 CLIENT NAME: DATE.RmiyW at Lair: (Drinking water)For <br /> t REC, BY(IRW-1) TIME Received at Lab: regulatory purpescs: Y1;SINO <br /> WORICORJER- y 17 t _~ -- - LOG IN DATE: (Wastewater)for a <br /> regulatory purlioses: YE1 SIVO <br /> x: CIRCLE T11E APPROPRIATE RESPONSE LAB SAMPLE DA'T'E <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDTRON(E-rc.) <br /> € 1. Custody Seals) Present/A -p <br /> : Intact/Broken* j —G I <br /> 2. Clfaitt-or-custodyresect Absent" <br /> 3. Traffic Reports or 4 <br /> Packin List. Pr nt/ <br /> 4. AirbiIt: <br /> n,lb /Stzctcer t/Absent <br /> 5. Airbill#: 2Le/ a4, <br /> G. Sample Labels; res it/Absent <br /> 7. Squiple ills; sic /Not Listed <br /> ou Clzaizs-nl�Czistnc! <br /> 8. Sample Condition: et/Broken*/ 1 <br /> Lealciri <br /> 4. Does InJonuatioa on <br /> custody reports, traffic � <br /> .reports acid sample <br /> labels agree? Y 1 NO <br /> 10. Swuple received within <br /> hold tint£: /No* <br /> 11. Proper Pxeservatives <br /> used: Ye J No" <br /> 12. Temp Rec.at tali:' <br /> (Accep(ance range for samples <br /> requiriog thernmil res.:414-212 Y !No's <br /> *if Circled, coeitact Project Manager and attach record of resolution, <br /> Sample Recefpt tag <br /> Revision 21 (1I M0100) F'0ge Ut <br />