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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME• tAfZS f <br /> DATE Received at Lab: .� f � (Dunking water)for <br /> REC. BY(PRINT) TIME Received at Lab: regulatory purposes. YES[NO <br /> WORKORDER• LOG IN DATE: ' <br /> � (� (Wastewater) for <br /> regulatory purposes: YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC) y <br /> 1 Custody Seal(s) Present/A <br /> Intact 1 Broken* <br /> 2 Chan-of-Custodyre t/Absent* <br /> 3 Traffic Reports or <br /> Packing List Present 16b,%dt <br /> 9 <br /> 4 Airbill r !t S �r <br /> G � <br /> s t/Absents( PV <br /> 5 Airbill# f/ 13 <br /> 6 Sam 1e Labels Apt:/Absent <br /> 7 Sample IDs ed 1 Not Listed <br /> on Chain-of-Custody <br /> 8 Sample Conditiont 1 Broken*I <br /> Leakm * <br /> 9 Does mforrnatron on <br /> custody reports, traffic <br /> reports and sample <br /> labels agree? A/No* - <br /> lo Sample received within <br /> hold time 6/No* <br /> 11 Proper Preservatives <br /> used AS I No* /✓ <br /> LLAan Rec at Lab U3 3 <br /> e range for samples <br /> hermal res 4+/-2°C) Y s 1 No* � <br /> 77 <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revision 21 (11110100) <br />