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0 0 0 <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME. ` DATE Received at Lab: (Drinking water)for <br /> REC.BY(PRINT) TIME Received at Lab: IZ regulatory purposes: YES/NO <br /> WORKORDER; LOG IN DATE: (1 _ (Wastewater)for <br /> regulatory purposes: YESINO g <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC.) <br /> } l Custody Seal(s) t! tti'- C,P <br /> n ct 1 en* <br /> 2 Cha in-of-Custody e t/Absent* pt,- <br /> 3 Traffic Reports or 11-11 1 <br /> Packing List Present/AGS <br /> 4 Airbill Airbill/Stir er <br /> Present/44t 4 <br /> S Airbill# <br /> 6 Sample Labels 6i—ht/Absent 41 <br /> 7 Sample IDs is /Not Listed l?7W— ~ <br /> D Chain-of-Custod n/ . <br /> 8 Sample Condition alun/Broken*! <br /> 9 Does informatton on <br /> i custody reports, traffic •j t -1411I ,AD 26-7qL- ` <br /> reports and sample <br /> labels agree? I Edo* <br /> 10 Sample received within <br /> hold time Q I No* <br /> It Proper Preservatives <br /> used I No* a <br /> 12 Temp Ree at Lab <br /> (Acceptance range for samples f� <br /> re <br /> utring thermal pres 4+/-2°C) YeS/No* <br /> tiro ,tn7-T7 W th<awv a .l+M 6 7 ai <br /> *If Circled, contact Project Manager and attach record of resolution, <br /> Sample Recelpl Log <br /> Revision 21 (11/10!00) Page of <br /> Replaces Revism 2(11106/00) <br />