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SEQUOJA,ANALYTICAL SA3ti PLF RECEIPT LOG <br /> CLIENT NAME, DATF.Recvi ed of T-Al r �•- -- - Drluking water for <br /> REC BY(MINT) TI]1iERccclzed at Lab. h1o6Zej regulatory purposes: YM NO <br /> NVORT{ORDI R., j/ ' LOG IN DA't h: �f�- 6 Z� Wastelyam fol � <br /> regulatory purposes: SIO <br /> r;'IRCI.F'i'1tl;ATrPROI'It1A'fEItESPC?NSE J. R CONTAT1jEIZ SAMPLE DATE REMARKS, <br /> SAA PLE 11 I; CLIENT ID T]F,SCII.II''1'fON MATRIX SAMPUM CONDITION C <br /> 1 CustodySeal(s) Present1 <br /> Intact I Broken* <br /> 2 cl;am-of-f ustnd Preso t f Absent* <br /> 3- 1'raflicRuport4or, <br /> Par kiniz List Pteseuf bsents <br /> 4.Aublll . Airblll I Sticker <br /> t - <br /> Frese>1t 1 bsc l <br /> S AirbM# <br /> G Sample Jzbeh [!Absent "f / <br /> 7 Sample,1Ds J ist f Not Listed _ <br /> i hain of-Costod <br /> 3 Sample Condition; Intact!Broken*! <br /> 9 Dore informalian on j <br /> custody reports,traffic <br /> reports and sample <br /> labels MT=? �►No* <br /> 10 ,S-amplcrcceivedwillpin <br /> hold irmc, NO <br /> 11 Proper Pr iervallvcs; r <br /> used Yes No* <br /> 12 7'einp Ree at Lab: <br /> (ACecplanca Yugo for Samples <br /> rNUIring [h�,rnisl pros 4Tf--21,C c—cs�40*R <br /> � ��Fxcc floe �falr <br /> *If Circled,contrtet Project Managet anti a!lfteh record of resolution. <br /> Sample Reaelpl Leg <br /> Reoslon 2 2(04f 11 foe) 1 <br /> 'lege <br /> Replaces RoVlsTon 2.3(11110100) <br />