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• • i <br /> SE QUOTA ANALYTICAL SAMPLE RE' CFIFT LOG <br /> Y.1Y/M- /_ Y• r a �r _ • r. •. ■,a - - r..a v r-s,ra �r r r irr+atri. .. wry <br /> I <br /> [.LININ l NAME, DATE Recencd at Lab. ` � l (Drinking water)for <br /> LX:C.BY(PRINT) nhiE iteceived at Lab + regUIRtory purposes y,', <br /> ti1'OI2}{OHUl�Ii• �( _ LOG IN DATH (Was(emater)fai <br /> L eg,ris(ory purposes y 'll� <br /> CIRC:LHTHE APPROPRIATE RESPONSE LAI3 SAMPLE DATE <br /> SAMPLE H ff CLIEWID DMCRIPTION MATRIX SA&,Ll'IXJ) COND riION(LTC.) <br /> 1. G��stody Sea1(s) Presen b t t.,s— LJI <br /> Litatt f �-�v <br /> 2 Chain-of-Custad 1 rc /AlAwO <br /> 3 Iraflic KcpOrts or DLI <br /> Packing List Present t2ga 1) <br /> 4 AtrUl Asrbdl 1:0&& <br /> Present {FSTt <br /> 5 Airbill# ; <br /> I 6 Sam lei Labels PFILAsIMl l Abccnt <br /> 7.Sample Ws T s ed/Not T isted ' <br /> en Chain of-clistotly <br /> S. Sample Conditionac Broken { <br /> ' 9 Does information on <br /> custody rtpuF%,lmfiic <br /> f <br /> reports and sample <br /> Iabch agree? <br /> l0. Sample recemd widita <br /> hold time 110; <br /> 11 Proper emrmervatives <br /> used No <br /> 17 Temp Ree,at Lab, <br /> (Acceptance range for samples <br /> r riy uirin 13icrmal Pros 411- Yes{Nu* I <br /> aaxea eros «�w..c4a axwnre`.w- _ wn r .xieweRoawa.arra it ..o-Frquest <br /> *Tf Cir clod, contact Projeet malinger and aftub record of resolution. <br /> Semple Reoeipt tag <br /> Raviaion 2 f(1111010QI <br /> Replaces Revision 2(11 W00) Page of <br /> Effectrm 1 N12F00 <br />