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i <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME- _ .5 ra:f&s�3P&Qn 61,00 DATE RECD AT LAB 6 �S��o� For Regulatory'Purposesl <br /> REC BY(PRINT) (_ >�s TIME REC'D AT LAB: /D;!S DRINKING WATER YES 1 NOF <br /> WORKORDER. M br u 1 DATE LOGGED IN �--Gy—�� WASTE WATER YES 1 NO <br /> (For clients requiring preservation checks at receipt,document here } <br /> CiRC1,E THE APPROPRIATE RESPONSE LAB DASH CLIENT IA CONTAINER PRESERV R SAMPLE DATE REMARKS <br /> SAMPLE# # DESCRIPTION ATIVE p -MATRIX SAMPLED CONDITION(ETC} <br /> 1 Custody Seal(s) <br /> Absent " <br /> (e. /broken* `v Af7t? S <br /> 2 Chain-of-Custody res t 1 Absent- b Rrrr <br /> 3 Traffic Reports or <br /> PackIng List Present Abso <br /> 4 Airbill3C-Xj i 1 Sticker <br /> resen l Absent <br /> 5 Alrblll# (o a <br /> 6 Sample Labels P /Absent <br /> 7 Sample IDsListe Not Listed <br /> on Chain-of-Custod <br /> S Sample Conditionn a /Broken*/ <br /> Leaking* <br /> 9 Does information on chain-of-custody, <br /> traffic reports and sample lab <br /> agree? /No* <br /> 10 Sample received within <br /> hold time? Y 1 Ido* <br /> 11 AdeL <br /> uate sample volume ' <br /> ved? LYe)/No* <br /> er Freseivabves <br /> ? Y /No* <br /> Blank 1 Temp Blank Received?(circlewhich,if Yes N <br /> p Rec at Lab <br /> p 4+/-2°C? Yes/No" <br /> e range for samples requiring thermal pros) <br /> ion(if any) METALS 1 DFF ON ICE <br /> oblem COC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION <br /> SRL Revision fi <br /> RRev 5(06107104) � Page ' <br /> r <br /> Efqp 07/13/04 <br />