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N 1 <br /> y SEQUOIA ANALYTICAL SAMPLE RECEIPT LOC <br /> CLIENT NAME, <br /> DATE REC'D AT LAB _ For Regulatory Purposes? <br /> 1REC.BY(PRINT) 9 TIME RECD AT LAB DRI1iK1NG WATER YES/ <br /> WORKORDER, Ufr � `�- DATE LOGGED IN. L- L} "�'f WASTE WATER YES/ <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CLIENT ID CONTAINER PRESERV pH SAMPLE DATE REMARKS., I <br /> { SAMPLE# # DESCRIPTION ATIVE MATRIX SAMPLED CONDITION(ETC) <br /> 1 ICustodySeal(s) Pr@sent/ se # W — �' L- I�" <br /> Intact/Broken* ,. <br /> 2 Chaln-of-CustodyPres t/Absent* v <br /> 3 frraffic Reports or -- <br /> Packing List Presen bse t <br /> 4 tAirbill Alrbill I Sticker r <br /> Pres nt/ se <br /> 5 Airbill It <br /> 6 Sample Labels ar 5e t I Absent <br /> 7 Sample iDs LI te-0/Not Listed ' <br /> oraln-of-Custod <br /> 8 Sample Condition ntac /Broken"/ <br /> Leakin <br /> 9. Does information on chain-Of-CListody, <br /> traffic teports and sample labels <br /> agree? eg No* <br /> 10 Sample riDceived within <br /> hold time'? I No* <br /> 11 Adequate sample volume <br /> received? e /No* <br /> 112 Proper preservatives use¢? ns I No* <br /> 13 ,Trip Blank/Temp Blank Recelved'2 <br /> circle which,If s YES/ <br /> 14 Read Tamp <br /> Cc i rected Te mp 5. 7 -C <br /> ,Is corrected temp 4+h2°C7 rs No" <br /> (Acceptance range for samples requiring thermal prey) <br /> *Exception (if any)' METALS / DFF 0 I•C <br /> or Problem COC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD Or RESOL ITION T <br /> SRL Revision 7 <br /> Replaws Rev 5(07113104) Page of <br /> iii Effecilve 07/19105 <br /> I <br />