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I <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> (J'INN'I NAME: /, DATE Receiver!at Lab' (Drinking wAtei) fur <br /> 11LC BY (PRINT) L' TIME Received at Lab- regulator},purposes. VESINO <br /> 5N 011K0111W,R LOG IN DAI E- I cit (Wastmuder)for <br /> regulatory purpaaes• VES/N0 <br /> C 111CLE 111E APPR0PRIAIE RESPONSE LA1i <br /> SAl►iP1vE DATE <br /> SAMPLE# # CLIENT U) DESCRIPTION A1A rM SAMPLED CON1}.l I IAN (E l C ) <br /> I Custody Seals) Present/lsse v �J <br /> Intact I Broken* r <br /> 2 Cham-of Custo{i 1"reser /Absent* <br /> 3 FralLic Reports or <br /> _ _Nanking List Present/1�iise>rt <br /> Aiiliill Airbill/Stier '1 <br /> Present/A sent -- <br /> 5 Atrbill It -- <br /> 6 sample 1 ab(ls /Absent <br /> 7 Sample IDs i f Not Listed 1 <br /> oil Chmir-o# Custod <br /> 8 Sample Conditioir Aga /Rroken*1 <br /> Leaking* - <br /> 9 Does irilouuatroll oil f �� <br /> ('11siody teporls, traffic ti <br /> reports and sample <br /> laud is agree es No* _ — <br /> 10 Sample icceived within f <br /> hold lime W/No* <br /> k <br /> 11 Koper Preservatives <br /> used Q, e- /Ifo* <br /> 12 I emp Rec of Lab -- <br /> (Acceptance image for samples <br /> ter iiir�ail pies 4 t-1-2°C) 1 No* <br /> F _ <br /> *ir ch clef], Colltact P1 oject Manager and attach record of resolution.Sample Receipt Log <br /> Revision 21 (11/10/00) <br /> Replaces Revision 2(11 M00) Pane n( <br />