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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> FEC. <br /> ME: ,2 co # f DATE RECD AT LAB: For Regulatory Purposes? <br /> R1NT) 7�4TIME RECD AT LAB• 22 DRINKINGWATER YES!Jt�ER: �fi� ��' - DATE LOGGED IN: WASTE WATER VZ NO <br /> {For clients requiring preservation checks at racelpt,document here ) <br /> CIRCLE THE APPROPRIATE RESPbNSE LAB DASH CLIENT IDCONTAINER PRESERV pH SAMPLE DATE REMARKS- <br /> SAMP!_E# # DESCRIPTION ATIVE MATRIX SAMPI.ED CONDITION(ETC) <br /> 1. Custody Seal(s) Present!Absent q A..-9_ LE `r C I ow ¢r L_ <br /> Intact/Broken* ,,. d. <br /> 2 Chain-of-Custody Present/Absent* s Q2_)—WA <br /> 3 Traffic Reports or 4 M vp <br /> Packing Llst Present/Absent Atw <br /> 4 Airbill /Sticker , <br /> elseia# <br /> /Absent vy 2 V <br /> 5 Airbtll#• v'� <br /> 6 Sample Labels. 5-r /Absent <br /> 7 Sample IDs /Not Listed <br /> on Chain-of-Custody <br /> 8. Sample Condition 416e—r/Broken*! <br /> Lealdn <br /> 9. Does information on chain-of-custody, <br /> traffic reports and sample labels <br /> arae? deal/Noy' <br /> 10. Sample received within <br /> hold time? /No* <br /> I 1 Adequate sample volume <br /> recelved'7 L01 No* <br /> 12. Proper Preservatives , <br /> used? No* <br /> 13 Trip Blank/Temp Blank Received? <br /> circle whi If es/No* <br /> 14.Temp Rec.at Lab, 3.(..4G <br /> Is temp 4+/-2°C'7 1b!No** <br /> (Acceptance range for samples rega1drig thermal pros) <br /> "Exception(if any). METALS ! DFF ON ICE <br /> or Problem COC <br /> *IF CIRCLED, CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION. <br /> _5RL Revision 6 <br /> Replaces Rev 5(06107104) Page_. of <br /> >=Hective 071i3J04 <br /> k <br />