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} <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME <br /> DAT RECD AT LAR For Regulatory Purposes? r <br /> R>=C.$Y(PRINT) COS TIME REC'I]AT LAS, O DR1t�1QNia WATER YF <br /> I trs' WASTE WATER YES 1 0 <br /> WORKOFIDER- " 1Vlo�4 t S DATE LOCzG1wl]!N. _ It �'J �. <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH_ CONTAINER PiESERV 9Atl�PI.E DATE= REMARKS <br /> = 1 <br /> SAMPLE# # CLIENT ID DESCRIPTION ATIVE PH MATRIX SAMPLED CONDITION(ETC) <br /> I Fustody Seal(s) son[ 1 <br /> In Broken* <br /> 2, Chain-of-CustodyPrese 1 Ahsen#' <br /> 3 Ttaffic Reports or ' <br /> PackingList Pre en Absen <br /> 4.IAirblll, rb111 Sticker <br /> 1 /Absent <br /> a. Airbill# l Za Z7Z3 <br /> 6 Sample Labels rase t l Absent <br /> 7 Sample las ted Not Listed <br /> ii o Chaln-of-Custod <br /> s <br /> S.Sample Condition n c ro cen*/ <br /> Leaking* <br /> 9. Does Information on chain-of-custody, <br /> I traffto reports and sample labe <br /> a Cee? es l No* <br /> 10 Sample received within <br /> hold time? es Na* <br /> ill Adequate sample Volume } <br /> received? a No* <br /> 12 'P �reseati�es use Ya /No* <br /> B <br /> ! circle which,if yes) I ND' <br /> 14 Read7amp <br /> ICorrected Temp <br /> Is corrected temp 4+I. C? Yes o�* <br /> �Accaptanco range for snmples requtnrig thermal pros) <br /> *"l=x,optlon(If any), METALS 1 DFF ON IC <br /> or Problem COC <br /> SFtglon 7 *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OP Paget <br /> RESOLUTION. f t , <br /> o> <br /> Re Rev 5(071I3104) <br />