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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME. Q P _ DATE RECD AT LAB. t 4" 0f; For Regulatory Purposes? <br /> REC. BY(PRINT) E . _Fet((t L1 _ TIME RECD AT LAB. 01,00 DRINKING WATER YES/I& <br /> WORKORDER: Kb,u t#4l DATE LOGGED IN. �/ y/fir WASTE WATER YES 11� <br /> CIRCLE THE PPROPRIATE RESPONSE LAB DASH CLIENT ID CONTAINER PRESERV PR SAMPLE DATE REMARKS <br /> SAMPLE# # DESCRIPTION ATIVE MATRIX SAMPLED CONDITION(ETC) <br /> 1. Custody Seal(s) Pent 1 Absent - yV1�'j-75 tw k V%)-tk(3) l-1 c { - L <br /> 19at/Broken* <br /> 2 Chain-of-Custody Pr nt/Absent* ►M w--7 <br /> 3 Traffic Reports or v►n+nl £i <br /> Packln-q List Present/AISs nt W <br /> 4 Alrbtll A&1/Sacker iM�N o <br /> Present l Absent w�yi <br /> 5 Alrblll-# CON 01001 006 447te 7079 Wthl�l2 <br /> 6 Sample Labels Prot/Absent VM w—Ls P <br /> 7 Sample lDs Lisod 1 Not Listed p is- G o?A 081VU,* w (7-) <br /> on Chain-of-Custody <br /> 8 Sample Condition IrWct/Broken*/ <br /> i <br /> Leaking* <br /> 9. Does informai]on on chain-of-custody, <br /> traffic reports and sample labels <br /> a ree? e /No* <br /> 10 Sample received within <br /> hold time? Y#b/No* <br /> 11 Adequate sample volume <br /> received? Y6 I No* <br /> 12 Proper preservatives used? _yo_/No* <br /> 13 ToftPlank 1 T6&,Blank Received? <br /> circle which,if es YW/No* <br /> 14 Read Temp ��a <br /> Corrected Temp <br /> Is corrected temp 4+/-2°C? Y8s/No** <br /> {Acceptance range for samples requidng thermal pros y <br /> **Exc9ptlon (if any), METALS / DFF ON ICE <br /> or Problem COC <br /> 60190%m 91FIRR <br /> • *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION, <br /> SRL vision 7 S <br /> Prov 5(D7/i3JD4) 0 Page 1 <br /> Eft 7!]91D5 <br />