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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: DATE Received at Lab: (Drinking water) for <br /> REC. BY (PRINT) AQ/ '7�4 TIME Received at Lab: regulatory purposes: YES/NO <br /> WORKORDER: LOG IN DATE: (Wastewater) for <br /> ND <br /> regulatory purposes: YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE 9 9 CLIENT ID DESCRIPTION MATRIX SEl) CONDITION(ETC.) <br /> 0"000' UV L,4!,In <br /> 1. Custody Seal(s) PreseA 'bselit — <br /> ) MW I LIA F <br /> Intact Br*C10 <br /> 2. Cliiia-of-Custodylr�esel /'Absciit* <br /> 3, Traffic Reports or <br /> Packing List: Present rA4=0L-'.'1 <br /> 4, Airbill: Airbill/ Sticker <br /> Present bserr <br /> sz <br /> 5m Airbill 4: <br /> qa2yile Ljbels.' CFLZE�Ni Absent <br /> 7. Sample IDs: (ZMte Not Listed <br /> on Chain-of CustodX zko' A <br /> Ate, i <br /> 8, Sample Condition: /Broken* <br /> Le Mllikiiig* <br /> 9. Does inforination on <br /> custody reports, traffic <br /> reports and sample <br /> labels a reel -n)s No* <br /> 10, Sample received within <br /> Bold Barre: No* <br /> t 1, Proper Preservatives <br /> used: No* <br /> L) <br /> 12, Teinp Rec. at Lab: <br /> (Acceptance rarige for sainples <br /> imeqLllrlll� thermal res .4+/-2°C) No* <br /> k77M7"7"Mr7 M-M 73M"'TNW' 6 <br /> If Circled, contact roM eM..cM!t WPMM <br /> ana <br /> * mer ...... <br /> atid attach record of resolution. <br /> Sample Receipt Log <br />