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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> �'LIENT NAME] DATE Received at Lab- —G (Drinking water)for <br /> IR <br /> 1tEC BY(PRINT) TIME Received at Lab. regulatory purposes. YESINO <br /> WORKORDER LOG IN DATE: (Wastewater)for <br /> regulatory purposes, YESINO <br /> h <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> ' SAMPLE# # CLIENT ID DESCRIPTION MATRIX SAMPLED CONDITION(ETC) <br /> I Custody Seal(s) Present1 bseii <br /> Intact 1 en* <br /> 2 Chain-of-Custodyreset t/Absent' 40 <br /> i <br /> 3 Traffic Reports or 6-5 <br /> PackiiiList Present I se <br /> 4 Arrbill Airbill 1 Sli er <br /> Present/ ser <br /> 5 Aiibill# <br /> G Sample Labels rese t 1 Absent <br /> 7 Sample IDs /Not Listed <br /> n Clialn-of-Custod <br /> 8 Sample Condition to t 1 Broken"/ <br /> 9 Does information ort <br /> custody repot ts, traffic <br /> reports and sample <br /> labels agree? Y 1 No* <br /> 10 Sample received within <br /> hold time XbV No* <br /> 11 Proper Preservatives <br /> used /No* <br /> 12 Temp Rec at Lab <br /> (Acceptance range for samples <br /> reuiru►= tliernl,►1 res 4+J-2°C} e I Tlo* <br /> nh mucks' u.Gcrk�YG w 1int+ rW,`. 5 b +.0\ "7 Z7 t W 7"M <br /> *If Curled, coliilact PI oject Manager Mid attach,record of resolution. <br /> Sample Receipt Log <br /> Revision 2 1 (11110104) , + Page of <br /> Replaces Revision 1(11106100) <br />