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f•♦ <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME. DATE Received at Lab: �� _ (Driolung water)for <br /> REC BY (PRIN r) TIME Received at Lab: regulatory purposes YESINO <br /> WORKORDER. bN Ot LOG IN DATE (Wastewater)for <br /> regulatory purposes- YESINO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC) r <br /> I Custody Scal(s) resen / q — so, .2 <br /> Intapt/Bro en* — <br /> 2 Charri-of-Custodyresent/Absent* -� z <br /> I 'Traffic Reports or i <br /> Packing List Present/ b <br /> 4 Acrbtll rtir /Sticker qT <br /> Preser�I Absent <br /> 5 Airbill# i z z <br /> R <br /> 6 Sample Labels rel /Absent 15Z x <br /> 7 Sample IDs List I Not Listed <br /> a Chain-of-Custod <br /> 8 Sample Condition Entad i Broken*I <br /> Le n * <br /> 9 Does information on <br /> c,ustod) reports,traffic <br /> reports and sample <br /> ljbcls agree Ye°/No* <br /> 10 Sample received within <br /> liold time Yeo I No* <br /> a <br /> 11 Proper Preservatives <br /> used / s/No* <br /> 12 1 emp Ree at Lab (0 <br /> (Acceptance range fox samples <br /> requiring thersuaf res 4+1-2°C') Yes/talo* <br /> > <br /> *If Circled, contact Protect Manager and attach record of resolution. <br /> Sample Reeelpt Loy <br /> Revision 2 1 (11/10100) <br /> Replaces Revision 2(111116140) page of <br /> Prra"f„A i T»?/nn <br />