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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME. S 7 d ! DATE RECD AT LAB: l DS __ For Regulatory Purposes2 <br /> -iREC. BY(PRINT) TIME RECD AT LAB 0S 13t> DRINKING WATER YE <br /> WORKORUER. t9 Lr � � � DATE LOGGED IN, 'Z /t�— 'l` WASTE WATER YESI <br /> ICIRGLE THE APPROPRIATE RESPONSE LAB DASH CONTAINER PRESERV SAMPLE DATE REMARKS: <br /> SAMPLE# CLIENT li] D>=SCRIPTION ATIYE pH MATRIX SAMPLED CONDITION(ET <br /> C-) € <br /> 1 ICustody Seal(s) Pr@sesent <br /> I t 1 <br /> 2 Chain-of-Custody rese Absent* E o(r 1144L- '3 <br /> 3 ,Traffic Reports or Q <br /> Paeft List Present 1 bse U-1 <br /> 4.'AirbfllSticker �L <br /> ' re Absent <br /> Y <br /> 5, Airbill# P/OP,a1 ���? - b1 -I N <br /> B Sam le Labels. t/Absent �- <br /> 7 Sample IDs- `s Not Listed fa L: 2SD y <br /> on Chain-of-Custody A ex- e- <br /> 0 <br /> 0 Sample Condition. n , /Broken*/ <br /> eakin * V .� <br /> S, Does information on chain-of-custody, f02 <br /> ,traffic reports and sample la <br /> agree? �e !!No* m <br /> 10 Sample received within <br /> Fri- <br /> hold time? 1 No' h 13.7 V `?l zVmS, V&a- <br /> 11.Adequate sample volume <br /> received? /No* <br /> 12 Proper presetvabyes used? dMs 1 No* <br /> 13 Trip Blank l Temp Blank Received? <br /> circle which,it es YW No* <br /> 14. Read Temp e' <br /> Corrected Temp e- <br /> Is corrected temp 4+!2°C? Y s Ne <br /> (Acceptance range far samples requiring thermal pros) <br /> nException(if arty) METALS / DFF ON ICE <br /> or Problem COC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OV RESOLUTION , <br /> I'-SHL Revision 7 <br /> I Replaces Rev 5(07/13/04) Page o! <br /> Effective 07/19105 <br />