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• lie - <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG � <br /> _ DATE RECD AT LAB z Z o s- For Regulatory r <br /> CLIENT NAME � ('G O 9 rlf Puroses?P <br /> RITC.AY(PRINT) e 41- TIME REC'D AT'LAE3•^ 'o o a H-. DRINKING WATER YES O' { <br /> WORKORDER: Her- 0 -Qy DATE LOGGED IN, (,, - L2- 6g WASTE WATER ,YES NO � <br /> (For clients requiring preservation checks at receipt,document here ) <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV SAMPLE DATE REMARKS* <br /> SAMPLE# # CLIENT lD DESCRIPTION ATIVE pH MATRIX SAMPLED CONDITION(ETC) <br /> 1. Custody Seal(s) Present! se -- VD-01- 6 WCA rL77 77 <br /> Intact/Broken* IA W ' s <br /> 2 Chain-of-Custody a -V Absenr +3 la w 1 O <br /> 3.Traffic Reports or AAW 17- V00- I2 + <br /> PackingList Present/ bs '$ r W <br /> 4 Airbill rb Sticker m rj2 G(o 6 21 Zo°S tr0-4- 2 <br /> Present 1 Absent VW 'x. W -- ' <br /> 5 Airbill# $346 vVf Vvv 3 <br /> 6 Sample Labels �t 1 Absent U W + <br /> 7 Sample IDs Cfsl Not Listed to Vvi 5' <br /> on Chain-of-Custody ► Dowu ti [ V mf i <br /> 8 Sample Condition- EaRl Broken*1 f <br /> Leaking* i <br /> 9. Roes iniormation art chain-of-custody, zfi <br /> traffic reports and sample labels j <br /> agree? Q/No* <br /> 10 Sample received within i f <br /> hold time? e /No* <br /> 11 Adequate sample volume l <br /> received? es No* <br /> 12 Proper Preservatives <br /> used? es No* - <br /> 13 Trip Blank/Temp Blank Received? I <br /> chain vMlch,U es NO* I <br /> 14 Temp Rec at Lab <br /> Is temp 4+/--2°C? 90 No— { <br /> (Acceptance range for samples requiring thermal pros) I <br /> **Exception (if any) METALS / DFF IC l <br /> or Problem COC I <br /> *IF CIRCLED, CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION. <br /> SAL Revision 6 Page <br /> Replaces Rev 5(06/07/04) ) <br /> Effective 07/13/04 ; t <br />