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{ SEQUOIA ANALYTICAL SAMPLE RECEIfP�T LOG <br /> CLIENT NAME: A 'l DARTS Rectived at Lab: b (Drinidug water)for y <br /> r <br /> RSC.BY(Pf2]NT) _ j�V�l TIl41E Received at Lab: r regulatory parposes: YES/N <br /> WORKORDER: LOGINDATE• (Wastewater)for <br /> regulatory Purposes: Y 4 <br /> CIRCLE THIS APPROPRIATE RESPONSE LAB dash CONTAINER SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCWPTION pH MAtM SA,IyIPLED CONDMON(HTC.) <br /> t <br /> 1. Custody Seal(s) est Absent <br /> /Broken* , <br /> 2. plain-of—custody( Presen Absent*• <br /> 3 A:rbill Airbill/Stic <br /> Present) sent <br /> 4 Airbnll# <br /> 5 Sample J*bela (fmciQ Absent <br /> 6 'Sample IDs- t-allNot Listed <br /> on Cham-of-Custody <br /> 7 Saimple Conditlon. ntac Broken*I <br /> 1 8 Does information on custody r6ports, <br /> traffic reports,and sample <br /> labels a see? No* <br /> 9 Sample r4cenved wtfhin <br /> hold mule. e /No* <br /> 10 Proper Peeservadves <br /> used qLeq1 No* <br /> 11 Tem eraktwe Blank Received? Na* <br /> 12. Temp Rec,at Lab' de c <br /> (Acceptance range for samples <br /> re <br /> uerin Q:srmal res:4+1-2°G) AesX10* <br /> 13. Smuples collec[ed,wore <br /> than 4 days ago? Yes*1 0 <br /> Sample{leceipl Log <br /> *If Oirci d, contact h oject Manager and attach recon d bf resolution. <br /> ( • <br /> Replaces z z(6130/04) <br /> 2Page of <br /> Replaces Revision 21 111]'i01DOj <br /> Effect[ve RAM FIGURE 6b <br />