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■� ■� � � �■ �� �■■■� tufa �■� �■� ti•ti• ■� w � itti• � <br /> t <br /> SEQUOIA ANALYTICAILPLE RECEIPT LOG <br /> CLIENT NAME` DATE RECD AT LAB {A L3 ami For Regulatory Purposes? <br /> 1REC,BY(PRINT) t-�tl�c _ TIME RECD AT LAB. 2�0 27 DRUIK1NG WATER YES 1 NO <br /> WORKORDER: k112 .1 b2/3 DATE LOGGED IN, --g WASTE WATER YES 1 NO <br /> {CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV H SAMPLE DATE REMARKS. <br /> CLIENT ID DESCRIPTION ATIVE p MATRIX SAMPLED CONDITION(ETC) i <br /> SAMPLE# # <br /> I ,Custody Seal(s) Present!Ott -p �» wa(4 tk z Sa y r- L I l3 cfi $ <br /> ' Intact 1 Broken* ' 14 T P 3 $ ( L- <br /> 2 <br /> 2 Cham-of-Custod e t/Absent* va°` �) t <br /> 3 Traffic Reports or g°Y'i S W 2-- <br /> Packjn2 List Present 1 A set a V <br /> 4 `Alrbill Airbill 1 Sticker <br /> i Presgnt/ s t <br />� 5 Airblll# .� <br /> 6 Sample Labels P e"nt I Absent <br /> 7 Sample IDs 1 Not Listed <br /> on Chain-of-Custod <br /> B ,Sample Condition JQ*1 Broken*1 <br /> Leakm <br /> 9. Does information on chain-of-custody, <br /> traffic reports and sample labels <br /> agree? `Z�/No* <br /> 10 Sample received within <br /> hold time? YVs No* <br /> 11 Adequate sample volume <br /> received? `a 1 No* <br /> 12 Proper preservatives used e I Na* <br /> 13 Trip Blank I Temp Blank Received? j <br /> circle which,ifes Yes I W <br /> 14 Read Temp s 5-1 -<- <br /> 'Corrected Temp S 'I L <br /> + <br /> is corrected temp 4+1-20C? )(D 1 No** <br /> I <br /> (Acceptance range for samples requiring thermal pros) <br /> **Exception(if any). METALS 1 DFF C E <br /> or Problem COC <br /> IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION r <br /> '' 1 SRL Revision 7 Page 1. -of <br /> Replaces Rev 5(07113104) <br /> Effective 07/19/05 ' <br />