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• i <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAh1E: 'r gyl� �i DlITE RECD A7 LAB! OR/ra�� For RoDttlatary Purposed <br /> REC.BY(PRINT) �( {�>w,-�. TIME REVD AT LAR;. �� 3t3 � M DRINKING WATER YESINO <br /> WORlCO DERE mfg 33 _ " tiATEl.00iGED IN; <br /> Id ID WASTEWATER YESINO <br /> (Forcllents requiring preservaicon checks at race7pt,document hare.) <br /> Cll�CI F THE APPROPRIATE RESPONSE LAK DASH � jLN7'AtNER PRESEAY N SAMPLE DATE REMARKS, ' <br /> &AMPt F Il' 4 CLI[NT1f3 pESCRIPTION ATIVE p r MATRIX SAW= C0rla1V0N(LTG.) <br /> ip <br /> 1 Custody Seaf(s) Present f sent i; Vc �- 0 S <br /> Irttactf Arakvn` _�C . _ Va <br /> 2 Chain-of•Custod resent Absenl* �t�1 <br /> 3 Traffic Ropvris or <br /> Packing I-is1• _ Ptesentf sort <br /> 4,fUtblll 111tIylll rcker W.�Q <br /> - JAbscut MW�to _ <br /> 5. AIr5111 fI: � n?1Jr �1 <br /> a Sam le Labols toren Absent _ M f) <br /> 7 Samlrlo 1As. rte Not Listod tl W.- D t <br /> on Chain-of-Custotl � <br /> tt, Sampla Condltcon, 0EN Broken'f Vs?a. all - <br /> Lealirn <br /> J. Does informailon on chaln-of custody, <br /> traffic reports and sample labels <br /> area? Ye No* <br /> 1 G.Sample trewivud Wlthnt <br /> 11014 1k[flIZ — <br /> 11 Adegaato sarnplo Volallltc - <br /> rocelved9 g f Na` <br /> 12 Proper Preservatives ' <br /> use leo' <br /> 1 rip Elank amp 8iank Rocolved <br /> (drde-0h,ch,it yvs a �1n` l <br /> 14 Temp Rec.at Lab - <br /> Is Up 4.9-2"G7 <br /> Vwwp;Rrxe rttngo for samples requiring IMrrnal was} �� <br /> `'Exccpticn(it any). METALS ! DFF ON ICE <br /> or Prob.em Cor. <br /> T 'IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION. <br /> 'SRI FevWNI ri <br /> liep;tc-0s fiov5(0"1104) Pare cFf <br />