Laserfiche WebLink
• 0 0 <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG _ <br /> t CLIENT NAME. /3 P DATE RECD AT LAS;_ " �� For Regulatory purposes? <br /> REG. BY(PRINT} l TIME RECD AT LAB: 1LJ:� DRINKING WATER YES 107 <br /> WORKORDER: 1�'lrll 010!1 DATE LOGGED IN: y/o ct WASTE WATER YES I IO <br /> (For clients requiring prbservation checks at recelpt,document here� ) <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CLIENT ID CONTAINER PRESERV SAMPLE DATE REMARKS- <br /> SAMPLE# <br /> EMARKS-SAMPLE# # DESCRIPTION ATIVE MATRIX SAMPLED CONDM0N(ETG.) <br /> 1. Custody Seal(s) Present A 01 A - IMtU" � A-3 Act, �Z <br /> - IntactBroker;* o 2-- o-, <br /> 2 ChaEsrof Custad Pros Absent` o �`I-oq : <br /> 3. Trade Reports or ev - :L <br /> 1 Paclang List Present 1 0 � - <br /> 4 AlrbIll Aifb1 B tn3�$ <br /> r6s i Absent f) r$ DLt-2- <br /> 5. Airbil!Il: b 03- ~1 VfJGt- <br /> ii. Sample Labels CP rose I Absent 0 <br /> 7 Sample IDs: r0W I Not Listed 10 <br /> on Ghain-of-Ccistad }n <br /> r 0 Sample Condition: 1 Broker*I 1 2- WSJ <br /> ( Leakln * I -2- <br /> 9 Does Information on chain-of-cbtody, 1 i <br /> traffic reports and sample lalaeyS <br /> 1 agree? C-)W1 No* <br /> 10 Sample received within <br /> hold time? l Ido" <br /> 11 Adequate sample Wtutme <br /> received? c No* <br /> 12 Proper Preservatives <br /> used? e !No* <br /> 1 rip Blan! T p ClanAK Rocetiv <br /> clrolewhlcl�,tf os Yo5 No* <br /> t 4 Temp Rea.at Lan. <br /> r is temp 4+1-2QC? <br /> {14eceptanca tango fir samples ragvirfng themot pros) <br /> r€xceptlon{if arty)' METALS 1 DFF ON ICE <br /> 1v Problom COC <br /> iIF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF REsOLUTION. <br /> rasion 5 <br /> +v A(11110103) PAge�of _ <br /> 114 <br />