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• i • <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME' 5P DATE Receives!at Lab: �� �` (Drinking water)for <br /> ILLC. BY(PM 1) C"'/ TIME Received at Lab: regulatory purposes: YES/NO <br /> W01MORDER -7 'L.,.,, LOG IN DATE (Wastewater)for <br /> regulatory purposes: YESINO <br /> CIRCLE TILE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC.) <br /> h <br /> 1 Custody Seals) Vta <br /> rt I r 3-�of2 <br /> roken (fC <br /> 2 Cha ui-of-Custody nese t I Absent* <br /> 3 Ti,.dTic.Reports or <br /> z <br /> Par-kin List Present/ bsel <br /> 4 Aiibjll trbjli ticker <br /> Pr ent/Absent <br /> 5 Aubill 4 ;Z1 <br /> 6 Sans lk,Labels es t/Absent ;27' ; <br /> 7 Sample IDs0111hA111-of-Custody <br /> I Not Listed f <br /> � <br /> sSainple Condition I&/Broken" / / <br /> Leaking* <br /> 9 Docs infunnatiou on / <br /> custody reports, IiMfic <br /> reports and sample <br /> labels a 1ec7 65e I No* <br /> 1U Sample lecclved within. 5 <br /> hold t111tc r §/No* <br /> 11 Pjoper Presol-VaUves <br /> mcd 61 No* <br /> 12 Z enlp ltec at Lab <br /> (Acceptatu.e cangefor samples <br /> h <br /> ICL LMHI�thermal les 4+1-2°C) es No <br /> v 5 rr a4ry �a> <br /> *if Circled, contact Project Manager and attach re rd of resolution. <br /> Sample Receipt Log <br /> Revision 21 (11110/00) <br /> Replaces Revision 2(11106M) Page of <br />