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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME- SkA,71" DATE RECD AT LAB For Regulatory Purposes? <br /> REC.BY(PRINT) _ f[ j TIME REC'D AT LAB: CC 45 DRINKING WATER YESN <br /> WORKORDER• �r b'33 DATE LOGGED IN- r(4 1 ID ': _ WASTE WATER YES/ <br /> (For clients requiring preservation checks at receipt,document here ) <br /> CIRCLE THE APPROPRIATE RESPONSE LAB DASH CLIENT ID CONTAINER PR ES ERV SAMPLE DATE REMARKS• <br /> &AMPLE# # DESCRIPTION A71VE pH MATRIX SAMPLED CONDITION(ETC.) <br /> 1 CustodySeal(s) Present! w- �XL� 77 L <br /> I roken* 1/0&. ,& <br /> 2. Chain-of-Custodynese 1 Absent* 1 l <br /> 3 Traffic Reports or 20en olk- Iuv <br /> IS <br /> Packing List Present4;;f M CL) — ea_ 114L= <br /> 4 Airbill Ir i Sticker --; <br /> M. /Absent uzs <br /> 6 Alrblll#k• 01001005 75,3bS <br /> 6 Sample Labels r s t/Absent <br /> ' <br /> 7 Sample IDs st Not Listed 1 vo3 <br /> on ain-of-Gusto <br /> 8. Sample Condition: c Bro en <br /> Leaking* <br /> 9. Does information on chain-of-custody, <br /> traffic reports and sample Ia <br /> agree? Yes No* 1 <br /> 10 Sample received withinC-L-- <br /> hold time? es No* <br /> r <br /> 11.Adequafe sample volume <br /> recetved9 B IND* <br /> L2er Preservatives <br /> a No* <br /> lank/Temp 81ank Receive <br /> hich,If s) a NO* <br /> Ree at Lab Z <br /> p 4+/-2°C� Y 1 Norange for samples requiring thermal Pres) <br /> n of any) METALS I DFF ON ICE <br /> blam COC <br /> IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION <br /> 'Ssion 6 page�L of <br /> Y Rev, (061671D4) <br /> ve Q7/t311 04 <br />