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SEQUOIA ANALYTICAL AIIIPLE RECEIPT LUQ _ <br /> 1l�J/ l [I)r1j&.itig mater) for <br /> CL3IsN I. Nr�.i�lls �/ r `"- � I �-' UA'IL Relet�rerl at L31f <br /> ItEC BY (I'ItiN1) — TiI�IC Received at Lab- 4"�D <br /> regulatory [till P.),C.S <br /> 1 ti �[�astt ia(er) for <br /> 11'ORKOI DER / J LUG IN DATE- <br /> regulatory purpmes. YESINQ <br /> CIRCLE IIII: AI'PRUI'RtAIL' RCSI'ONSL LAI3 ilastl CUNTAINI+R SAMPLE DAIR <br /> SA11iPLIa CLIEN f ID DESCitIPi1C)N pii MATRIX SAt�ll'LIaD CUNIliliUN (L`1C:.) <br /> l/v Q� A � <br /> L Cu�iod} Seal(s) ' e_Se l Absent <br /> ttttac. 1 Brokc,uf <br /> L Utattt ul-Custud 'resent Abseut' — <br /> 3 AubiLl Sticker - <br /> tltllbscllt — — <br /> 1 Airbilt 3& -5 01/S—d5 / <br /> 5 S alit is Labels QiesettY Absent. <br /> G Sarnpk.311 tst I Not Listed <br /> ut 'lain-of-Custody �- <br /> 7 Sautlllt.Condition tt 113roken* / <br /> Leakin " <br /> 8 Does infol mattou on custody repoi ts, <br /> tiallle rt;pui(5 and Simple -- <br /> iaUels agree 3 C)No' -- - <br /> t) 5aniptc lcicl�Ld within / — <br /> huld time (Y-r Nok Y <br /> ltl Proper Plc%etNativi:s -- <br /> used �Now <br /> I r <br /> L Iem etatmeMankRuLeived7 Yes N f __- <br /> 12 1 enip Rec at Lab Z— degrees c — <br /> I <br /> (4(,LeptYn1LC range foi samples <br /> ictlutrm 7 tl�mwt SLS �i/-2'C) Yes No' ��- <br /> 13 Satitiples collected inut5 <br /> i1mil cla}s .►' Yes no - <br /> 'lf Cis cleci, contact I'ti�jeek �llaua et,- and attach tem d ul tesolittioll. Jv <br /> Sainttln E tocellil LDtg i p <br /> n1 <br /> i <br />