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r ar = Mom = M r r us s <br /> 4r <br /> j SEQUOIA.ANALYTICAL SAMPLE RECEIPT LOG <br /> m HttDATE Received at Lab 9-0-03 (Drinking seater) for <br /> VLIENT NAME: 112 <br /> REC. 13Y(PRIIyT) ✓ TIME Received at Lab regulatory purposes � YES/NO <br /> � WORKORDER LOG IN DATE, ✓� (Wastewater)for <br /> regulatory purposes' YESINO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB i SAMPLE DATE <br /> SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC) <br /> wo 47 <br /> 1 Custody Seal(s) <br /> Present 1 set �� � <br /> Intact I B en* <br /> I <br /> 2 Chani-of-Custody 1?tes t/Absent* <br /> 3 Traffic Reports or <br /> PackingLis( Present I bseint &14/--/9 — 0/ <br /> 4 Atrbtll Atrbllt I Str r <br /> Present/AV ` <br /> 5 Arrbill# <br /> G Sam (e Labels res tit/Absent �� - <br /> 7 Sample IDsoilliaiti-of-Custody d I Not Listed <br /> 8 Sample Conditiona t I Broken*/ <br /> Le tt * <br /> 9 Does information on <br /> custody reports, traffic <br /> reports and sample <br /> labels a rce7 Q/No* <br /> 10 Sample received within <br /> hold tune s/No* } <br /> 11 Proper Preservatives <br /> used 1 No* <br /> 12 Tenip Rec at Lab <br /> (Acceptance range for samples <br /> Jrequiruig thermal Eres 4}/-2°C) s/No* <br /> l �kv.c. `C �6 R" <br /> 'elf Circled, contact P1 oject Manager and attach,record of resolutio <br /> Sample Receipt Log <br /> Revision 21 (11/10/00) i page of <br /> Replaces Revision 2(1 iAXW) t <br />