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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> n f� <br /> t CLIENT NAME: J DATE Received at Lab. b T (1)tiolttrtg tenter) for <br /> REC 11Y(PR1N 1) TIME Received at Lala: bregulatory ptnposes YESINO <br /> WORKORDER• LOG IN DATE: 2 —Cr-z (Wastemi(m)for # <br /> regulatoiy purposes, YES/NO ' <br /> CIRCLE'i HE APPROPRIATE RESPONSE LAB SAMPLE DA I'E <br /> SAMPLE # CLIENT 1D DESCRIPZION MAI RIX SAMPLED CONDITION(EFC) <br /> t <br /> g 1 Custody seal(s) Present/Ase yl,t <br /> s <br /> lil Broken* <br /> 2 Cham-of-Custod i(espO IAbseit* <br /> i 3 TuLffiic Repot t5 or <br /> Packing List Present!AGA) t <br /> 4 Aublll I 1 t <br /> P e t I Absent k <br /> S AubillIt ijz q 9g $Okq <br /> 1 G Sam lle Labels es t/Abseil! <br /> 7 Sample IDs is /Not Listed <br /> o Main-of-Custod <br /> 1 8 Sample Condition TWAt 1 Broken"1 <br /> Leaking* <br /> 19 Does information on <br /> i <br /> ctistody lepolts,traffic £ <br /> relloits and sample <br /> libels a lee l N/No* <br /> 10 Sample received within <br /> hold tune /No* <br /> I1 Ptoper Presel-natives <br /> used ya/ o* <br /> - 12 1 emp Rec at Lab <br /> (Aca.plalice range for samples <br /> Iulilrul theiuc;ll ices 4l/-2°C a /No* <br /> *If Cil cletl, contact Pi oject Manager and attach i ecorcl of resolution. <br /> Sample Recelpt I og <br /> Revlslon21 (11!10/00) __ _ PegE UI <br />