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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG • <br /> CLIENT NAME• DATE Received at Lab: I _ (Dnnking water)for ; <br /> • TIME Received at Lab: = regulatory purposes. YES <br /> REC. BY (PRINT) r"7'� <br /> WORKORUEIt• ) LOG IN DATE- (Wastewater)for <br /> regulatory purposes: no <br /> No <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC.) <br /> I Custody Seal(s) resent t Absent — H ' "1 ij ` 14 <br /> lntac Broken* 4 <br /> 2 Chain-of-Custodyre �Absent* <br /> 3 Traffic Reports or � <br /> Packing List Present bsetii t <br /> 4 Atrbill Atrbi ticker ` ' <br /> /'resent/ bsent <br /> I <br /> 5 Airbill# E, 385 5 =i _z 1+F <br /> 6 Sample Labels PresentAbsent 12,44 <br /> 7 Sample IDss d!t Not Listed 12-9 <br /> on Chaiti-of-Custody <br /> 8 Sample Conditionntact! roken*I <br /> Leaking* <br /> 9 Does information on. <br /> custody reports, traffic <br /> reports and sample <br /> labels agree I Yes/00*) <br /> C3 <br /> i <br /> 10 Sample received within <br /> hold trine o* ' <br /> It Proper Preservatives <br /> used e No* <br /> 12 Femp Ref. at Lab <br /> (A(,ceptance range for samples <br /> Le utrtng thermal pres 4+-1-2°C) (Yes!No* <br /> w<r <br /> *If Circled, contact Project Manager and attach record of resolution. <br /> Sample Receipt Log <br /> Revtsion 21 (11110100) Page of <br />