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s ` <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> W. C <br /> FilSEC, <br /> ENT NAME: c� 6 DATE RECD AT I.AB- �ibysFor Regulatory Purposes? <br /> TIME REC'U AT LAB. a, <br /> DRINKING WATER YEyS <br /> t3Y(PRINT) �, f1 . WASTE WATER YESRKORDER: DATE LOGGED IC�1. <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV SAMPLE DATE REMARKS: <br /> SAMPLE# # CLIENT ID pH MATRIX SAMPLED CONDITION(ETC) <br /> 1.ICfastody Seal(s) z Prise d Abs <br /> ct 1 rotten* <br /> 2 Chain-of-Custody res t!Absent; I <br /> 3 Trafflo Reports or <br /> Packing List Presen s <br /> 4 `Alrblll. I/Sucker <br /> r n Absent <br /> 5 Alrblli#k I� <br /> B Sample Labels 1 Absen <br /> 7 Sample IDs st d/Not Lasted <br /> o ain-of-Custod <br /> s Sample Condltfon Intac /Broken*/ <br /> Leakln * x> <br /> 9. Does information on chain-o#-custody, <br /> traffic reports and sample <br /> agree? s I No* <br /> 10 Sample-received within <br /> hold bme'2 /No* 01 <br /> 11 Adequate sample volume <br /> received? 1 No* <br /> 12 Proper presetvatives used? /Noy` <br /> 13 Trip Blank I Temp Blank Received? <br /> clrclewhfch,3I s Yes No" <br /> 14 Read Temp ' <br /> Corrected Temp <br /> Is corrected temp 4+1-2°C?QY_ /No** <br /> (Acceptance range for samples requlnng thermal pros) <br /> *.Exception(If any). METALS I DFF ON ICE <br /> or Problem COC <br /> swamaw <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION. , <br /> SRI.Revfslon 7 Page t o <br /> Replaces Rev 5(07113104) g <br /> Effedve 07118/05 ' <br />