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I <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> Jl— v - ..Yavy4�C..U.S:rM •,,--r� a. _�!v� .w.71.t"" X-1 fly,r�rfl <br /> s CLIENT NAMEv DATE AEC'D AT LAB k z Foi Regulatory Pui po-,as? ;f <br /> iREC BY(PRINT) TIME REC'D AT LAB ,�� DRI(}KING WATER YES 0 <br /> IWORKORDER < q �s" DATE LOGGED IN /f.»_] __" WAsrE WATER YES 04 <br /> E CIRCLE THE APPROPRIATE RESPONSE LAB AASH CONTAINER CLIENT Ill PRESERV pH SAMPLE DATE REMAIIKS <br /> I <br /> r SAMPLE# # DEVIPTION ATIVE MATRIX 5 PLE=D CONDITION(ETC) <br /> 1.(Custody Seal(s) Present Apse m <br /> lnta Broken* <br /> 2 Chain-of-Custod rase Absent* <br /> 3 Traffic Reports or I <br /> PackingList Present se m <br /> 4 Airblll. TAIll ticker ►Zqe /Absent <br /> 5 AirbiII# j3 <br /> 6 Sample Labels resen /Absent all <br /> 7 Sample IDs fisted of Listed <br /> r on Bain-of-Gusto <br /> 8 Sample Condition nta Broken / <br /> Leaking* <br /> fj <br /> 8 Does information on chain-of-custody, <br /> traffic eeports and sample lapels *` <br /> agree? Ye /No- <br /> 1 <br /> No* <br /> 1110 Sample received within <br /> hold times Ye /No* <br /> 11 Adequate sample volurne �i� <br /> e received? (-�!eS/No* <br /> o*g1312 Proper prw3wvafives used? Ye 1 No- <br /> 113 <br /> Trip Blank/Temp Blank deceived? <br /> >F <br /> (circle which,If es) Yes Q No <br /> k14 Read Temp <br /> Corrected Temp <br /> Is corrected tomp 4.1/-2°C? e /No** <br /> {Accopluncs rango <br /> for samples ruqu,nng lhorm-l pros) <br /> *"Exception(if any) METALS / DFF ON ICE <br /> or Problem COG <br /> *1F CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OP RESOLUTION r <br /> SRL fievlslan 7 <br /> *es Rev 5(07113104) <br /> PAnp 0f <br />� e 07118105 , <br /> I <br />