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w <br /> SEQUOIA ANALYTIA SAMPLE RECEIPT LOG L� � <br /> . r.r-r xhuTaitt.�,t•aln.«lyFd. <br /> CLIENT NAME, DATE EC'D AT DRINKING WATER for <br /> RSC BY (PRINT) -e TIME RE-G'b AT LAB regulatory purposes" YFS! <br /> - -- -- - <br /> WORKORDEFi � TM`.`.. TJA rE LOGGrED IN _ .2-41-6V � WASTt WATER <br /> for-regulatory purposes. YES ! <br /> _- GIRCLI='fHE ApPRO�RIATE( SPONSE r_Ar3 DASH V— CONTAINERF�1;ESE SA 1Pi.E DATE 1 MARKS -- <br /> 9AMPLE O IS T tD DESCRIPTION ATIVE MATRIX SAMPLED CONDITION(FTC) <br /> 1 Custody Seals) Present!A _f °•� !� 1 L&II& <br /> Intact!Broken" <br /> Chain-of-Custody r1'Stt IAbsenr <br /> 3 riafc Reports or <br /> Packing List Present/Ab( ' <br /> 4 ATrbill ibl f sticker �} ' <br /> e , f Absent _ I <br /> 5 Airbilf 0 FlyD' <br /> 6 Sam leLabnls• rase (Absent <br /> 7 Sample lOs e !Iat l'IsCecf : __V•W __ <br /> - <br /> S Sample Conditionac RroKen'! - <br /> i11 � <br /> _ 9 Does nnformation ori <br /> chain-of-custody,traffic - <br /> roportb and sample <br /> labels agree? <br /> 10 Sample recewed within <br /> hold time. <br /> 11 Adequate sample volume �• <br /> received �es No' _ <br /> 12 Proper Piesetvatives - <br /> used W <br /> 13 Temp Rec at Lab_ 3 .- <br /> Is temp 4}I-?" '� ��P#` _- --L <br /> Qplan�range!for SampTes fequiring the AWISrea)xceptiloll any iUllti IAI,9 1 DEF Old 1GF _ - — <br /> ar Problem COC_ - <br /> Sfli_ivd-xds IF CtRCLEU CONTACT PROJECT MANAGER AND ATTACH RECORD Or RESOLUTION <br /> Re%,1SW d(11110103) _ - Page t of( <br /> Repla oo 5 Revision 3(03I1 8ff}3) - <br /> -ilectvre 11 ri GV03 <br />