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SEQUOIA ANALYTICAL SAMPLE RECEIPT <br /> ��LOG <br /> CLIENT NAME: btn DATE RECD AT LAB: ( �. [ ;Q-_� For Regulatory Purposes? r <br /> IREC BY(PRINT) TIME REC'D AT LAB. 4°Iy DRIi�[ NG WATER YES I tg <br /> FWORKORDER. 1'1 bDATE LOGGED]IN. WASTE WATER YES/0 <br /> 1CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV SAMPLE DATE REMARKS. i <br /> SAMPLE# # CLIENT ID DESCRIPTION ATIVE pH MATRIX SAMPLED CONDITION(ETC) <br /> 1. CustodySeal(s) Prgsentl set T ( A <br /> Intact/Broken' ' { <br /> 2 Chain-of-Custody ese t 1 Absent* .i Vow E <br /> 3 lTraffic Reports or w t <br /> Packing Llst Present l set T - 7 - A k ` <br /> 4 :Airbfll Airbdl 1 Sticker (z <br /> Present/ s)nt <br /> 5 Afrbll# v%, c,.( <br /> 6 Sam le Labels es t!Absent 1.9- 3- A <br /> 7 Sample Ins 1st /Net Listed <br /> L- <br /> on Chain-of-Custodyv w- 13 W it,-, <br /> 8 Sample Condltlon 16 a4t 1 Broken*/ W - 1 1 _ <br /> Leakin * �. - 2- <br /> 9 <br /> 9 Does information on chain-of-custody, <br /> !traffic,reports and sample labels <br /> agree? , Xe2j No* U- <br /> 10 Sample received within 1 L c[ (t <br /> hold time? /No* 5uo w►1 ;Zxl ! <br /> 1 i Adequate sample volume a/117a {4) k4 G I <br /> f received? `a /No* <br /> 12 Proper preservatives used? Y 1 No* g' W <br /> 13 Trip l3lank/Temp Blank Received? b <br /> circle which,If es IDBS/ * VV-0 - ML)I I L p <br /> 14 Read Tamp, uo 4� o[ <br /> ConectedTomp �'7 C- �/ wog 6 ) <br /> Is corrected ternp 4+1-2°C? e /Ne* 06 - AAw 2 <br /> (Acceptance range for samplea requiring tharmal pros) I W p� Q (}�- <br /> "txceptlon(it any), METALS I DFF CN IG <br /> or Problem COC MW 2- V . <br /> *IF CIRGLF_D,CONTACT PROJECT MANAGER AND ATTACH 1 OLATION. <br /> SRL fan 7 Page of e <br /> ,Replacess Rev*(07/13104) <br /> Effective 07119106 <br /> , <br />