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r. <br /> SEQUOIA ANALYTICAL_ SAMPLE RECEIPT LOG <br /> CLIENT NAME: (15DATE Received+at Lab: Drinking water for <br /> REC.BY(PRINT) _ �� _ TIME Received at Lab: ? regulatory purposes: YES 1�i0 'I <br /> WORKORDER: f-Ike, V& 9 LOG IN DATE: � -(, —o j Wastewater for !: <br /> regulatory purposes: YES! O <br /> CIRCLE THE APPROPRIATE RESPONSE LAB CONTAINER SAMPLE DATE �� : <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION TC. <br /> 1. Custody Seal(s) Present(0ient <br /> Intact/Broken* 9 <br /> 2. Chain-of-Custody Present(Absent* (AJ <br /> 3. Traffic Reports or <br /> Packing List: Present 1 Absent... C, <br /> 4, Airbill: Airbill/Sticker <br /> Present/We t� <br /> S. Airbill#: <br /> 6. Sam le Labels: CPlYgmt/Absent <br /> 7. Sample IDs: iste Not Listed <br /> on Chain-of-Custody <br /> 8. Sample Condition: � I Broken*I <br /> t <br /> Leaking* <br /> 9. Does information on <br /> custody reports,traffic <br /> reports and sample <br /> labels agree? j Yes/No* <br /> 10. Sample received within / <br /> hold time: CYC2/No* 1 i <br /> 11. Proper Preservatives i <br /> used: est=No* j <br /> 12. Temp Rec.at Lab: <br /> Is temp 4+/-2°C? Yes/No** ! <br /> (Acceptance range for samples requiring(hennal Pres.) / <br /> **Exception(if any):Metals/DFF on ice?/DFF no ice? <br /> 1' or Problem COG <br /> *If Circled contact Pro'ect Mang er and attach record of resolution. <br /> Sample Receipt Log <br /> Revision 2.3(12/23102) <br /> } Replaces Revision 2.1 (04111/02) Page of <br /> �/Q a Hective 12124/02 <br />