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F, SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: DATE REC'D AT LAB, q,20 For Regulatory Purposes? <br /> Y PRIM o[►^C®S TIME RECD AT LAB: r�QQ_, DRI KING WATER YES 1 <br /> ` RRC.13 { T) � --� <br /> I <br /> WORKORDER: <br /> i 67 b�4 a- DATE LOGGED IN: OI �•�� �'� WASTE WATER YES IO <br /> { i <br /> CiRCLI=THE APPROPRIATE RESPOND4LAB DASH CONTAINER PRESERV SAMPLE <br /> DATE REMARKS: I <br /> ' f LE# # GENT ID TDESCR1P`nON ATIVE pH MATRIX SAMPLED CONDITION(ETC) f <br /> i.iCustody Spal(s) Prgsf�nt bse <br /> +' Intact/Broken* �Y <br /> 2. Chain-of-Custodyrose 1 Absent* <br /> 3 Traffic Reports or <br /> Packfn List 1 Pr ent 1 bsent n -16 <br /> 4.`Airbill. tlrbll��It <br /> Sucker yy <br /> I I Absent ' 77- �»- 3 <br /> 5.Alrblll#. IUDI nl' -� LL ( --00 a <br /> 6 Sample Labels, Nese /Absent <br /> i <br /> 7 Sample IDs Listed of Listed —3 <br /> f o Chain-of-Custod It <br /> e ,Sample Condition• luta t/Broken"1 <br /> Leaking; 1} ! ILI <br /> 9. Does information on chain-of-custody, 2005 uoel <br /> traffic reports and sample labels <br /> a ree? es/No* <br /> 14 Sample received within f <br /> hold bine? es No* <br /> 11. Adequate sample volume I = <br /> received? I 6Z1 Ne <br /> 12 Propy <br /> er reservatives used? 3 1 No* <br /> 1 rip Blank ITemp Blank Receiv <br /> circle which,iE es ' Y 1 No* <br /> 14 Read Temp <br /> Porrected Temp s <br /> ,1s corrected temp 41.1-i 1 Yes 1 No" <br /> (Acceptance range for samples raqulrtng thermal pros) <br /> "Exception(if any) METALS / DFF ON ICE <br /> or Problem COC I <br /> *IP CIRCLED, CONTACT PROJECT MANAGER AND ATTACH RECORD OP RESOLUTION <br /> SRI,>3 7 ' r Page <br /> Replace v 5(07113104) <br /> s , FffertivP M111 9/i15 + , <br />