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i • 0 <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME. UVA DATE Received at Lab: (Drinking water)for <br /> REC. BY (PAINT) TIME Received at Lab: regulatory purposes: YES/N0 <br /> WORKORDER. LOG IN DATE: (Wastewater)for <br /> regulatory purposes: YES/NO <br /> CIRCLE THE A.PPROPRUTE RESPONSE LAB <br /> SAMPLE DATE <br /> SAMPLE 9 # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC.) <br /> 1. Custody Seals) t Absent <br /> Pnet/Broken* <br /> 2. Chain-of-Custodx k'1 Absent* <br /> 3. Traffic Reports or 11531"-� (7V <br /> PackinE List-, Present gb -19 <br /> 4. Airbill: <br /> Pftnt Absent <br /> S. Airbill#.- <br /> 6. Sample Labels; jgpVt I Absent <br /> 7. Sample Ws. /Oxi/Not Listed <br /> on Chain-of-Custody <br /> S. Sample Condition: <br /> Eta)/Broken* <br /> Leakig* <br /> 9. Dm information on <br /> custody reports,traffic <br /> reports and sample <br /> labels agree? Q/No* <br /> 10. Sample received within <br /> hold time: nlNo* <br /> 11. Proper Preservatives <br /> used: No" <br /> 12, Temp Rec. at Lab: <br /> (Acceptance range for samples <br /> requiring thermal -eres.:4+/-2°C) I No* <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sampfe Receipt Log <br /> Revision 2.1 (11110100) <br /> 14 Page <br /> of <br />