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',rr .r r� rr rr rr r rr i r s r r ri r ■r �r r� rr <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: `r DATE Received at Lab: Drinking water for <br /> `G=B '�' T� _ _ C� TIME Received at Lab: L regu[at ory purposes: TM/NO <br /> II —f�-,�- ... <br /> j WORKORDER: db� - LOGIN PATE: Vvastewatertar <br /> regulatory purposes:lato YES/NQ <br /> CIRCLE THE APPROPRIATE RL+"SPONSE LAB CONTAINER SAMPLE DATE RL,mss. <br /> SAMPLE# # CLIENT IDDI�SCRIPTION TRIX SANTLED CONDITION TC <br /> 1 Custody seal(s) Present! sent <br /> + Intact/Hroken* <br /> } 2 Cham-of-Custod enC Absent" <br /> E 3. Traffic Reports or <br /> 2acking List Preseast/�bsm , <br /> 4.Arrball Airbill/Sticker <br /> Prese /A se t <br /> s 5 Alrball# <br /> d Sample.Labels Prese Absent <br /> 7 Sampla 1'Ds s /Not Lasted <br /> OR Chin-of-G�lstod , <br /> j 8 Sample,Condition In /Broken,*/ <br /> I.eakm <br /> 9 hoes information on <br /> custody reports,traffic <br /> reports and sample <br /> labels ree? Y /No* <br /> r <br /> 10 Sample received wathan <br /> hold time- / o* <br /> 11. Propt'ar Preservatives <br /> used /Na" <br /> 12 Temp Rec at Lab. �Z_"eq <br /> Is tamp 4+/-rC? �7NO*ft <br /> (Acceptance range for samples requumg thermal pros) <br /> **Exception(if any) Metals/DFIt on ice?/DIFF no ice? <br /> or Problem ICOC 5 <br /> i <br /> ' sample Receipt rag *If Circled ontact Project Manager and attach record orresoltation. <br /> i Revlslon 2:1(12123/02) <br /> Replaces tkeWslon 21(04111N2) ! Pape of <br /> -'Effective'f2/24/02 <br /> I ''s <br />