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lorry, mom kmr ire "an immi* �� .ter � 601M ■mm fes■ res *env dm.ir "m1r � r.w..► <br /> i <br /> SEQUOIA ANALYTICAL SAMPLE RECENT LOG M, b <br /> N (Dking water)for <br /> LIENT NAME' � DATE Received at Lab, �/�.� 3 rinF <br /> REC BY (PRINT) <br /> TIME Received at Lab. ®` regulatory Iiuriioses YESINO <br /> WORKORDER. C.p LOG IN DATE' (Wastewater)for <br /> regulatory purposes: YES/NO <br /> s <br /> ' SAr4PLE DATE <br /> CIRCLE THE APPROPRIATE RESPONSE SAMPLE 4iCLIENT ID DESCRIPTIQN AIATRiX SAMPLED CONllIT10N(ETC) <br /> 1 Custody Seals) Present 1 ✓�"`" <br /> Intact/Bj!�p j <br /> 2 Chmn-of-Custody rese /Absent* <br /> 3 Trallic Reports or <br /> Packing List Present bsent <br /> 4 Atibill Airbill l S er ' <br /> Present/ sent <br /> 5 Anbill# <br /> 6 Sample Labels Xr-esefi I Absent <br /> 4 <br /> 7 Sample Ips s 1 Not Lister! t <br /> 1 � <br /> Chain-of-Custod <br /> I8 Sample Condition tasil!Broken*I <br /> 9 Does infoiniatiou on <br /> custody reports, traffic <br /> ieports and sample <br /> labels a ree? Ye No* <br /> io Sample received within <br /> Bold time No* <br /> 11 P1oper Preservatives <br /> used As/No* <br /> 12 Temp Rec at Lab <br /> (Acceptance range for samples <br /> rec tricin theiiilal res 4+/-2'C) s 1 No* <br /> :: <br /> If Curled, confilet Project Manager mid attach,record of resolutioil. <br /> bample Receipt Log <br /> Revision 21 (11/10100) page of <br /> Replaces Revision 2(11106100) <br />