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w, w ■w w w ■■w w w w w <br /> SEQUOIA ANALYTICAL*MPLE RECEIPT LOG <br /> CLIENT NAME: T t C' DATE RECD AT LAB ld , 63 For Regulatory Purposes? ! <br /> T} � - <br /> TIME REC'D AT LAB. 4it?1115DRIIVNG WATER YES kn <br /> IDER <br /> R!"C.BY(PRINT) <br /> 61 DATE LOGGED IN. 0 "I4 '�'� WASTE WATER YES t9 <br /> I <br /> 1CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV H SAMPLE DATE CONDITION(EIC) z <br /> ISAMPLE4 # CLIENT iD DESCRIPTION AT VE p MATRIX SAMPLED <br /> 1 lCustody Seal(s) Present/ bs t �* IL <br /> Intact I Broken* it I L P0I (2} <br /> 2 Chain-of-Custody res t 1 Absent* <br /> 3 ?raffic Reports or � l <br /> Packing List Present 1 AGs—eht `L VCR (c) C- <br /> 4 <br /> 4 'Airbill Alrbili 1 Sticker 00&w- VCR <br /> Present 1 AbQnt by A I P I A { L Po 1 <br /> 5 Airbill# = 1 —G L W (c) [+C <br /> 6 Sample Labels Rr&nt/Absent 0% A. Z e Z A 1 L {i -- <br /> 7 Sample IDs L t /Not Listed C L f (t) f1 <br /> on Chain-of-CustodyL� "— <br /> e Sample Condition IQ#/Broken*1 E <br /> Leakin * <br /> 9. Does)information on chain-of-custody, 0°i (ai) �L� <br /> traffic teports and sarnpie labels P A D<�114 <br /> agree? YtAl /No* G) <br /> 10 Sample received within V V Q PAW- i y a (2.) <br /> hold times Ye—$1 No- l L [2 <br /> 11 Adequate sample volume <br /> received 'Cos,/No* i l aWA <br /> 12 Proper preservatives used? 1 No* M)A 4 C <br /> 13 Trip Blank 1 Temp Blank Received? �� `�`"�°`r (q H L <br /> circle which,Ifyes)_ Yes 1 May f I ( <br /> 14 Read Temp 1 9-4 Al <br /> Corrected Temp 5 1 <br /> C 6 P 2 l L a4►,lnr(z) <br /> Js corrected temp 4+1-200'7 1o!No** i L ?-I (L) <br /> (Acceptance range for samples requiring thermal pros) kvN 0 <br /> **Exception(if any)- METALS 1 DFF Cot <br /> or Problem COC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OP RESOLUTION. <br /> SRL Revislon 7 Page of <br /> J Replaces Flov 5(07113104) <br /> Effective 07/19/05 ' <br />