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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: DATE Received at Lab: — t� —fy—� (Drinking water) for <br /> REC. BY (PRINT) TIME Received at Lab: � regulatory purposes. YES/NO <br /> 3 <br /> WORKORDER: LOG IN DATE: (Wastewater)for <br /> regulatory purposes: YESINO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SA 1PLED CONDITION(ETC.) <br /> 1. Custody Scal(s) Present 'Absel VV <br /> ILA=/Bro en* <br /> 2. Chain-of-cusLoC[ reSelr Absent* <br /> 3. Trafric Reports or <br /> Pac[tin =List: Prescat/ sent <br /> 4. Airbill: Airbill/ t - r <br /> Freser bse <br /> S. Airbill4: <br /> t C,. Sani rle Labels; t/Absent <br /> 7. Sample IDs: ItO I Not Listed <br /> o [aim-of-Custod <br /> 8. Sample Condition: ntac I Broken* I <br /> [Il <br /> 9. Does Information on <br /> custody reports, tra11ic <br /> reports and sample <br /> labels agree'? s No* <br /> [ <br /> 10. Sample received within <br /> Bold time: 1 No* <br /> 11. Proper Preservatives <br /> b I No* / <br /> 12. Tei tip Rec. at Lab: 3 <br /> (Acceptance range for samples <br /> rec t++nn tlacrmal res..4 12 711' 7 <br /> C e / <br /> No* <br /> *if Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revision 2.1 (1 111 oloo) I <br /> Page of <br />