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t <br /> SEQUOIA ANALYTICAL SAMPLE/ RECEIPT LOG <br /> IDATE RE 'D AT LAB / J For Regulatory Purposes? 3# <br /> CLIENT NAME: DRI ICING WATER YES I <br /> iREC BY(PRINT) _ c TIME REC'D AT LAB.u Gf�i _. <br /> r <br /> ORKORDER- � (�� b 3 �— DATE LOGGED IN. f2 �'�~°' WASTE WATER YES J O <br /> E <br /> 1 <br /> I3 <br /> ICIRCLE THE APPROPRIATE RESPONSE LABI'T <br /> CONY SERV SAMPLE; <br /> AINER P <br /> SAMPLE# CLlEtI71D DESCRIPTION ATIVE MATRIX SDATE REMARKS: <br /> CLIENT CONDITION PC) i <br /> a:E <br /> 1 1Custody Seals) n 1 Absent f <br /> nta Broken' <br /> 2 Chain-of-Custody res 1 Absent* <br /> 3.Traffic Reports or <br /> Packin List <br /> Present <br /> 4 ;Alrblil r I Sticker <br /> ! res /Absent <br /> 5 Airbifl# O <br /> 9 Sample Labels t/Absent <br /> 7 Sample IDs- CLstdd/Not Listed <br /> oham-of-Custod <br /> 8 Sample Condition t 1 Broken*/ <br /> Leakin <br /> 9. Does information on chain-of-custody, <br /> i traffic reports and sample labals- <br /> agree? /No* <br /> 10 Sample received within <br /> hold time? Ye J Na* <br /> 11 Adequate sample volume <br /> received? Ye /Ne <br /> 12 Pro er preservatives used? 1 No* <br /> 1 Ia kljl�lank Received? <br /> (drde which,if yes es No* <br /> 14 Read Temp <�'� • { <br /> Corrected Temp _' S <br /> is corrected temp 4+1-2°C? 1 No** <br /> (A009ptance range for samples requiring thermal eras) <br /> Exception (if any), METALS I DFF ON ICE <br /> Tr Problem COC <br /> • *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RE-SOLUTION. <br /> I SRL Revision 7 <br /> I Replaces Rev s(07113!04) Page al <br /> s <br />