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s • 0 <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME- DATE Received at Lab. 9--1-03 (Drmkung water)for <br /> REC BY(PRINT) lip TIME Received at Lab. regulatory purposes: YESINO <br /> WORKORDER LOG IN DATE: (Wastewater)for <br /> regulatory purposes: YES/NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC <br /> )J- <br /> I <br /> I Custody Seal(s) Present/0 bs t, <br /> I Token* <br /> 2 Chain-of-Custody rese /Absent* <br /> 3 Traffic Reports or <br /> Packing List Present/A sent <br /> r <br /> 4 Airbill Alrbill/Stic I <br /> Fres Abs t <br /> 5 AErbill# <br /> 5 Sample Labels Pr t/Absent <br /> 7 Sample IDs ist /Not Listed <br /> on Chain-of-Custody <br /> 8 Sample Conditiontart 1 Broken*/ <br /> Leaking* <br /> 9 Does information on <br /> custody reports,traffic <br /> reports and sample b <br /> labels agree? Y s)/No* <br /> 10 Sample received within <br /> hold time 4 e No* <br /> 11 Proper Preservatives <br /> used Yes/N * <br /> 12 Temp Rec at Lab -- <br /> (Acceptance range for samples <br /> re uirLn thermal eres 4f/-2°C) ne 1 No* <br /> *If Circled, cont ct Project Manager and attach record of resolution. <br /> Sample Receipt tog <br /> Revision 2 1 (11/10100) <br /> Rt pl jcr-s Revistun 2(111MoO) Page of <br /> Elft Ldp 13!12100 <br />