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F-- <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> DATE Received at Lab: �Q (Drinking water)for <br /> CLIENT NAME. <br /> REC. BY(PRINT) <br /> TIME Received at Lab: t/j regulatory purposes: YES1N0 <br /> WORKORDER: L LOG IN DATE: q (Wastewater)for l <br /> regulatory purposes: YESINO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC.) <br /> 1. Custody Seal(s) nO Absent L <br /> t/Broken* <br /> 2. Chain-of-Custod e t I Absent* <br /> 3. Traffic Reports or <br /> Packing Lisl: Presentb t <br /> 4. Airbill: �0— k/S sci �^1 <br /> res t/Absent <br /> 5. Airbill#: <br /> 6. Sample Labcls: es ;t/Absent <br /> 7. Sample JDs: 1 Not Listed <br /> or Chain-of-Custod fix; a <br /> 8. Sample Condition: nt I Broken*/ <br /> Leakin * <br /> 9. Does infounatioll on tb Gzwt QS <br /> custody reports,traffic � � g <br /> reports and sample ' <br /> lapels a ree'1e !No* <br /> 10. Sample received within <br /> hold time: /No's <br /> 11, Proper Preservatives <br /> used: <br /> No's <br /> 12. 'temp ltcc.at Lab: <br /> (Acceptance range for samples <br /> re uirij►, thermal res.:4+/-2°C) ffeNo* <br /> . x ;. . <br /> If Circled, contact* Maga er a F... <br /> * "tEtach record of resolution. <br /> Sample Receipt Log <br /> Revision 2.1 (1ill 0100) Mage of <br /> Replaces Revision 2(11/06100) <br />