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i <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT L00 <br /> 99.41 <br /> CLIENT NAME: r��5 _ DATE RECD AT i..AB. � � �U� � For Regulatory PurpaseV <br /> REC.BY(PRINT) TIME FIEC'D AT LAS._ IG3 _ DRINKING WATER YES/ <br /> WORKORDER: _ O j� bea `� — DATE LOGGED IN; _ � �_� a� WASTE WATER YES <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CLIENT 1t) CONTAINER PRESERV pH SAMPLE DATE REMARKS <br /> i SAMPLE# # DESCRIPTION ATIVE MATRIX SAMPLED CONDMON(ETC) <br /> 1 Custody Seal(s) Present Abse 6 a. �a I <br /> Br0 en* a'Y C� i <br /> 2 Chain-of-Custody Fres t l Absent* <br /> 3 Traffic Reports or <br /> Packing List, I'r se <br /> 4 Alrbill 65rSPI Sticker <br /> r9& 1 Absent <br /> 5 Atrbill# S <br /> 8 Sample Labels t Absent <br /> 7 Sample 1Ds Is Not listed <br /> on Chaln-of-Custod <br /> 8 SamplsCondition. e'1=61 Broken',/ <br /> eakrn ` <br /> 9. Does information on chain-of-custody, <br /> traffic reports and sample lab Ij a ree? Y I No*10 Sample received withinhold time? Y s1No* <br /> I 1 Adequate sample volume <br /> received? e I No* <br /> 12 Proper preservatives used? e 1 Noy' <br /> 13 Trip Blank I Temp Blank Received? <br /> (circle which,If es) Yes No* <br /> 14. Head Temp, , <br /> Corrected Temp <br /> {s correct8a temp 4 fl-2-0? Yes/fro** <br /> (Acceptame range for samples requiring thermal pres) <br /> "Exception(if any) METALS / DFF ON ICE <br /> or Problem COC <br /> ^ *IF CIRGLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION <br /> 5AL Revision 7 r� <br /> ReplacesRev 5(07/13/04) Pagelot/ ' <br />