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� <br /> SEQTJOXA AhALYTXCAL SA MYLE RECEIPT LOG <br /> CUMItl�.t)M; ��1� � � DATE Receaved at Lab: �� X)rtnlung wratcr for <br /> RFC.By(1'I?.>iNM %� TME Reeeived at Lsb. regulatory purpo sec• YES y 4 <br /> y WORKORDER. b `� LOG Il�DATE• ..,, 71 Waster Ater for <br /> regulatory purposes YES 0 <br /> CIRCLE TaT,A 11RO ATE RESPONSE LAB COIVTAM-ER S1�WLE DATE REMARKS <br /> SANCLE# _ X CLWN XD DESCRtMOI! T= Sal A COND 1z;'TC.) <br /> 1. C=tody SOMI(S) Prccent 1 scat - ,.. 1..9 <br /> Xn okw <br /> Cama-o r C tad aresc l Aj080nC* #tA V <br /> S TraMe Reports or (/V g <br /> Facld>ac J�ist< �tesant Anse �4.� v{f w- <br /> 4 hj7bi*ll. Aubl i S vv Q ! <br /> Pr .oat Aub <br /> � S 1�roill#' <br /> 6. Saa1 to Labels' Absent 1 <br /> 7. &zaple lDs ,f at Listed <br /> j 8. S=ple Conr4aor J4ta rokce I <br /> 9. Does udormatron.on <br /> 4 =Aody reports,t-affic <br /> rcparts lad SX-11Ple <br /> c :abds e? Yes 1`r0* <br /> . <br /> 10 Ssstplc roee.ved vntbm <br /> bald tuac Yes 1 0* <br /> 11 Proper Prem vatm <br /> used Yes Ne* <br /> 3 12 T=p Rca.aL lab: <br /> (Acceptance rengc for samples <br /> nquuang tharmm--1 pres,4-"1-2°C) Yes Ze'k'� <br /> " Excevaon(:Lf <br /> V Girded. contact Fro ect'Kamxger and attach record of resolution. <br /> Stimplo Remp Log <br /> vision 2,2(04111102) " <br /> acos Rovlsion 21 (1 1.110/00) Page of <br /> 04J751�32 <br />