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1 f - <br /> f , <br /> ' SEQUOIA ANALYTICAL SAMPLE RECEIPT LOC <br /> 7'ijRECBY <br /> AM1~: - DATE RECDAT LAS (2 �o S Por Regulatory Purposes? PPRINT) t TIME REC'I]AT LAB' 1 � i]RIIV,KING WATER YE51 <br /> DI:R. b L b DATE LOGGED IN. Q�1 t��' WASTE WATER YES/ <br /> �CIIICLE THE APPROPRIATE RESPONSI~ LAB DASH CONTAINER PRESERV H SAMPLE DATE REMARKS <br /> f <br /> SAMPLE# S CLIENT ID DESCRIPTION ATNE p MATRIX SAMPLED CONDITION(ETC) t <br /> 1. Custody Seal(s) RF r t 1 Absent <br /> ! Broken* <br /> 2 Chain-of-Custodyrase 1 Absent* <br /> 3 iTraffic Reports or <br /> PackingT <br /> ust Present Abse <br /> 4 'Alrbill Sticker <br /> MP-rese2t/Absent <br /> S. Alrlall{# DIM 1i JS?!?2W2 <br /> 6 <br /> Sample Labels djjCnt I Absent <br /> 7. Sample IDs last d/Not Lasted <br /> on C in-of-Custod <br /> 8 Sample Conditlon U&CLIO Broken*1 <br /> i_eakin <br /> 9. noes Information on chain-of-custody, <br /> traffic teports and sample labels <br /> a ree? Y I fro* <br /> 10. Sample received within <br /> hold time? es No* <br /> [14 <br /> dequate sample volume <br /> eceived? I No* <br /> Proper preservatives used? No* <br /> n em lank Received? <br /> circle which,if s /No* <br /> Read Temp. <br /> Corrected Temp �s corrected temp 4+1-2°C7 Ye I Nc** <br /> ptance range for ssmples requiring thermal pma) <br /> **Exception fif any), METALS I DFF ON ICE <br /> or Problem CDC <br /> *IF CIRCLER, CONTACT PROJECT MANAGER AND ATTACH RECORD OP RESOLUTION. <br /> F 1 vision 7 <br /> s Rev 5(07113104) 0 Paga <br />