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C <br /> SE,QUOLA ANALYTICAL SAMPLE RE,CCIPT LOG <br /> iA,IL,LN1' 1 A N I E DATE Received at Lab: � C' <br /> (Drinking ti`ate3-)ft►3• <br /> REC. BY (HUM) `I'[.ME Received at Lab: j } regutatury purposes: N'FS/iVQ <br /> `!V10)l;)t: � �,+ �� LOG IN DATE: � (Wastewater)for <br /> regulatory purposes: <br /> CIRCLE 'I•lll? APPROPRIATE RESPONSE LAIC sAMr'Lr; I)A'C[a — — --V— <br /> SAMPLE#i # CLIEYr it) I)ESCRLPTION MA'FI7Jx SAC GI! C'ONDC.i'IOIY(r-TC'.) <br /> I. t'r151ud). Sul(s) Present/ �C11 }�,- � ;� � � � � Iq �3- <br /> 11€tact 18ro1cclt* - <br /> z, f'lE.�i€€ of t.'ir5lu�ly res I Absent* <br /> 3. Traffic Rcp- tts or -- <br /> 1',11;1Ui1' St: —f'1CSCi11 t?s -- — <br /> 4. Akbill- Airbill f Sticker - ---- -- <br /> Preserrt 1-�AWwA -- _ <br /> 5. Air#gill W: -- <br /> G. S- -i pte Lat,cis. A->e /Absent <br /> 7. 8,imple lt?s; t j Not Listed - `-- <br /> -T. L]I3 ChAill-of-Ct€stocl r " --- -----". <br /> 8. S€ nple f ouditiali: 11z I Bfoken* - <br /> -- Uaking* —� W <br /> 1). Does iniimnation ott --------- <br /> uustc�ciyrclttnts, traffic <br /> reports mull sa111ple - �- <br /> _.__.. <br /> _ 1<lbels a€;rce'? �fYes Not <br /> 1€old liruc: ' 1No° — — <br /> 11. Piupel Prusur+ufiti-cs - - <br /> nSLiIY ^ �, /No* <br /> 12. '1'entl� lac. al Lib: -- w- <br /> x (,'Inc-,ptaucv.ril€ge for samples + — <br /> r c rririn IhcLiires.:4 1-/-2 IQ Ye Nor <br /> *if Circled, Contact Project Manager and Attach record of res01336031. <br /> Saiuille Rki,eipt L43g <br /> Revisiurt 1.i (1 111 woo) <br /> i aces t:: 2(11;05100) page_� of«--- <br />