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• �r <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG _ <br /> ` CLIENT NAME- SIP DATE REC'D AT LAI3: �"���._ � For Regulatory Purposes? <br /> REC. BY(PRINT) � TIME RECD AT LAB; .' DRINKING WATER YES 1� <br /> F WOE�Kc}RDEI4, t"'tNC� 2�(o�f _ DATE LOGGED IN.. 7 7/0 WASTE WATER YES 1(g? <br /> (For clients requiring pr6ervation checks at receipt,document here j ) <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH '� <br /> CLIENT IU CONTAINER PRESERY SAMPLE DATE REMARKS: <br /> SAMPLE# # % DESCRIPTION ATNE MATRIX SAMPLED CONDMON(ETQ j <br /> 1. Custgdy Seal(s) PresentCA 4 t A '� rnw 1747 cT -Z <br /> IntactOrokerl" 07-- W <br /> 2 Chain-of-Custodyroso AbseiW Q '�j_p <br /> 3. Traffic Reports or cQ - <br /> Paddrig List Present t {1J <br /> 4 Airbfll Airt�l - Wim$ <br /> res 1 Absent e�' >�- #}r'-2- <br /> 5. Alrbill!t- D 8' - -ti? Vo&-� <br /> 6. Sample Labels: nj�lAlbsi E7 t.11 <br /> ' 7 Sample IDs: f Not Listed <br /> on Chain-of-Custodyyn <br /> 8 Sample Condition- t Srokerl'1 <br /> ( Leakln * J W - <br /> 9 Does Information on chain-of Astody, I !r t <br /> traffic reports and sample labe <br /> agree? 1 No- <br /> 10 <br /> o- <br /> 10 Sample received within <br /> hold time? s J No' • <br /> 11 Adequate sample volume <br /> received? a No* <br /> 12. Proper preservatives ` <br /> used? a NO <br /> 1 rip I31an T p i5iariKC ecoiv <br /> dme tch'If os Y95 No; <br /> i4. Temp Rea,at Lab Ve tis temp 4+1--2C? o** <br /> k(Accaptunca Tanga for samples requlring thermal Pres <br /> k&cepton <br /> (if any)' METALS 1 DFF ON ICE <br /> 4 Problem COC <br /> *1F CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLU110N. <br /> �siatt 5 <br /> 'a 4(191'FuiD3) Page_Z_of _ <br /> 14 <br />