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SEQTTOTA ANALYTICAL SAMPLE RECEIPT LUG <br /> I DATE Received a#Lab. Drinking grater for <br /> CLIENT NAME• t <br /> 1tEC.BY(PRINT) TIME RcCeived at Lab. a��.� regulatory purposes, <br /> WORKORDER: ��3 d LOG IN DATE: Wastewater far <br /> regulatory purposes. YES <br /> C>tRCLE THE APY'1tOPArATE RESPONSE LAB CONTAINER SAMPLE DATE REMARKS: <br /> SAMPLE# # CLIENT ID DESCRIPTION MATS SAMPLED CONDI'I XON C. <br /> I Custody Seals) Present Absen <br /> Intact!Bro a <br /> 2 Cham-of-Custo t I Absent* <br /> 3 Tiafio Reports or <br /> Paclan List Present been <br /> 4 Airbiil Aubill 1$t Ar <br /> Present <br /> s Aiilrill# <br /> 6 Sample Labels Absent <br /> 7, Sample IDs Nut Dstcd <br /> o Chain-of-Custody <br /> 9 Sarnlile Condition ntact Brolreri*/ <br /> n * <br /> 9 I)oes information on <br /> custody reports,traffic <br /> reports and sample <br /> labels agree? <br /> No* ' <br /> 10 Sample received within <br /> hold time Q/No* <br /> 11 Proper Pieservatrves <br /> used es No <br /> I2 'Temp Rec.at Lab <br /> Is temp 4+l-rC? s l No* <br /> (Ac Ttmw range for sampk*requumg thermal prey) <br /> **Emptlon(if any),Metdls/DFF on ice?/A zw tce7 <br /> or Problem COC Z:j <br /> I <br /> Sample Receipt Log *If arcled,_contact Pr'oiectManager and attoch_rexurd of resolution. <br /> R941ori 2 3(42123102) <br /> Replaces Aevlslon zt OWI 1102) Page __of <br /> Elfecllve I Z24W <br />