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s <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: E It C- _ DATE RECD AT LAB. 10 113 1 br7 For Regulatory Purposes? A <br /> fREC.BY(PRINT) E , F& y% - TIME REC'D AT LAB: DRI INKING WATER YES/I@O <br /> WORKORDER. 14 10Sb!q ( DATE LOGGED IN. r6 WASTE WATER YES/ <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV 9AMPLEJ DATE REMARKS: 1 <br /> SAMPLE# # CENT ID DESCRIPTION ATIVE AH MATRIX SAMPLED CONDITION(ETC) <br /> 1.1Custody Seal(s) PrgsentI A qt b T W - Wd (C {-FGf t o 2 1! <br /> Intact/Broken* <br /> 2 Chain-of-Custody P es nt/Absent* 1 - 2- <br /> 3 <br /> Z3 ;Traffic Reports or -3 <br /> Packing List. Present 1 nt b r - <br /> 4 `A[rblll Alrbl[I/Sticker 0 -- <br /> Present! s t <br /> M <br /> 5. Airbiil# G1[ 8 <br /> 6 Sample Labels P es nt/Absent W - IQ <br /> 7 Sample IDs. L 1st /Not Listed 12 M W - I <br /> on Chain-of-Custody 11 R - <br /> 8 Sample Condition. frits s Broken*1 2 <br /> Leakm * <br /> 9. Does information on chain-of-custody, ► - 1 <br /> traffic reports and sample labels - '2- <br /> a-gree? <br /> 2- <br /> a ree? 1&/No* 1 <br /> 10 Sample received within t <br /> hold time? e I No* <br /> 11 Adequate sample volume _ 2- <br /> received? e /No* �,� - <br /> 12 Proper reservatives used? e /No* d <br /> 13 Trip Blank/Temp Blank Received? y - I - <br /> Lards which,it s Yes/ * .2 - 1 — 0 <br /> 14 Read Temp. ` S, �j ° C_ 2 - 2,-A E <br /> Corrected Temp ,Q ' �- <br /> Is corrected temp 4+/--2°C? 1O!No** Y4 - 3- A <br /> 09tance range for samples raqulring thermal pros) 2 - :�—113 <br /> 9ption(if any): METALS ! DFF 011 E <br /> `roblem COC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD 01~RESOLUTION. <br /> wlsfon 7 ' <br /> i Rov 5(07!13104) Page of <br /> 17119105 <br />