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SEQUOIA ANALYTICAL SAMPLE RECE[PT LOG. <br /> CLIENT NAME: 13�,will� �r� DATE RECD AT LAB: �-/I--cs"�" For Regulatory Purposes? f <br /> REC.BY(PRINT) TIME RECD AT LAB-, 1 86 DRINKING WATER " YES 1 l•' <br /> WORKORDER: � �1�t DATE LAGGED IN: X14 t'-ID WASTE WATER YES/t `' <br /> CIRCL;=THE APPROPRIATE'RESPONSI~ LAB- DA5H C411;NT ID CONTAINER PF ESERV pH <br /> " SAMPLE ' DATE " Rel$1aRtC3; <br /> SAMPLE¥ # DESCRIPTION ;ATIVE MATRIX SAMPLEI} CONDITION(ETC.) <br /> 1. Custody Seal(s) Present/A <br /> Inta " oken* . <br /> 2. Chain of Custod rese Absent* <br /> 3.Traffic Reports or. <br /> t <br /> Pacicin Llst: Present/ sen <br /> 4. Alrbill: Airbili/S 1 er <br /> Present l A� ,. <br /> .5. Airbill#: :} <br /> • It <br /> 6. Sample Labels: res Absent <br /> 7. Sampie IDs: ste Not.Listed <br /> on 290n-of-Custody <br /> i <br /> 8. Sample Condition; nta Broken'/ l� <br /> Leaking <br /> 9, Does information on chain-of-custody, t <br /> traffic reports and.sample labels" <br /> .agree? <br /> 10. Sample received within <br /> hold time? <br /> 11. Adequate sample volume <br /> "received?. o* <br /> 12. Proper preservatives used? Y No* V <br /> 13.Trip Blank/Tamp Blank Received? ' <br /> (drdie which,it es) E <br /> 14. Read Tetnp: ' <br /> Corrected Temp: fr I <br /> Is corrected temp 4+/-2'C? Y No** <br /> (Acceptance range for samplas requiring thermal pres.) <br /> *`Exception(if any); METALS /.DFF ON ICE l' " <br /> • or.Problem COC <br /> *IF CIRCLED,CONTACT.r 'ECT MANAGER AND.ATTACK RECORD OF RESOLUTION, <br /> Roylslon T Page t - <br /> �a oo <br /> P,,.r,1071ta/041 <br />