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F <br /> SEQUOM ANALYTICAL SAMPLE RECEIPT LOG ' <br /> CLIENT NANO: _ G s DAVE Received at Lab: rt—.Z4-6!5 <br /> Drinking water for S . <br /> y REC.BY(PRINT} TIME Received at Lab: regulatory u oses: YES/4 <br /> WORKORDER: MG 00 LOG IN DATE: -01 - 03 Wastewater for <br /> regulatory purposes: YES/ ) <br /> � CMCLE THAPPROPRATIZ RESPONSE CONTANRSAMLE DATE <br /> g,EMAW; <br /> SAMTLE# # CLIENT'M •DESCRIP'I`fON MATRIX SAWLED CONDITION TC. <br /> i I <br /> 1. Custody Seal(s) Present/VEenit <br /> Intact/Broken* ¢y <br /> 2. Chain-of Custod 1 Absent* 3 <br /> 3. Traffic Reports or b <br /> Pacl�n List: Present!4 sen p� <br /> 4. Airbllh Airbill/Sticker o <br /> /Absent07. <br /> ' <br /> S.Airbill#: W! - <br /> 6. Sam Ie Labels: e I Absent d <br /> 7. Sample IDs: e t Not Listed <br /> on Chain-of-Custody <br /> 8, Sample Condition: tact Broken*/ <br /> Le_ <br /> 9. Does information on <br /> custody reports,baffle <br /> reports and sainple- <br /> labels a ? Yes No* ,a <br /> 10. Sample received within <br /> hold time: es o* <br /> 11. Proper preservatives <br /> used: es No* <br /> 12. Temp Rec.at Lab: <br /> Is temp 4+/-2"C? ��4* <br /> (Acceptance range for samples requiring thermal pres.) <br /> "amption(if any):Metals I DFF on ice?1 DFF no ice? <br /> or Problem COC <br /> . } ., ....... _ resolution. <br /> t - *If Circled, contact Project and attach record of <br /> Sample Receipt log <br /> Revision 2.3(12123192) 1 <br /> +.Replaces Revlslon 2.1 (iki/11l02) Page <br />