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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOC <br /> CLIENI NMIE: DATE Rec-eived at Lab. (;;J-2 ,6 6 f (Dnaking water)For <br /> [IEC. J3 (PXIIN 1) TIME Ite+.elved at Lab. nC160 regulatory purposes. YESINO <br /> NVORKORDER. LOG IN DATE: (Wastewater) for <br /> regulatory purposes: YES/NO <br /> CIRCLE'l IIE APPROPRIA I E RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CUEN I ID DESCRIP'T'ION MATRIX SAMYLED CONDII[ON(ETC.) <br /> 106tody Seal(s) Present,/ bsezl w \/V <br /> Intact/Bloken* 2 <br /> 2 Chain-of-Custodycse /Absent* rid <br /> 3 1'raflic.Reports of <br /> 11a(1111 L 1st Present/'� sel }j <br /> I Amblll Ii{/ C { <br /> re lit/Absent 1 , <br /> 5 Aubill4 _ 0 2- <br /> 6 Sant Ic.Labels i res /Absent <br /> 7 SampiL IDs clsv1 Not Usted <br /> on Climix-of-Custod � C, Vvt <br /> S Samph.Condition xxt t/Broken* 1 {t)0[ <br /> Leaking* i <br /> 9 Dins inruu1aatlou on <br /> cuslud) ICpU1l5, tralrC <br /> Ieports mid sample <br /> labels a glee! e, / No <br /> 10 Sample keened milun <br /> 11014 t1lm, /No* <br /> I I PI opCI Pit sen olives <br /> 1 NO <br /> 11 Z emp Rec at Lab _ <br /> (AWxp(allc.c ldrlg",for samples <br /> �c:tut114 y 1t1�1111a[ 1cs 4 -1-2"C) e /No* <br /> n} i .. i S t i f ti L3x p.� ♦i K+"i S�„J' s f 1 IXb <br /> Js.A Yc*--i ,s. <br /> s J <br /> *1f Circled, contact Project Manager'nu�l- ttach record of resolution. <br /> Sample Receipt Log <br /> Ravision 7 1 (11/101m) <br />