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SEQUOIA ANALYTICAL PLE RECEIPT LOG <br /> CLIENT NAMEWORKORDERQ <br /> REC BY (PRINT) DATE OF LOG-IN t� <br /> CIRCLE THE APPROPRIATE RESPONSE LAS <br /> SAMPLE DASH CONTAINER SAMPLE DATE REMARKS <br /> 1 Custody Seal(s) Present bse # # CLIENT IDENTIFICATION DESCRIPTION MATRIX SAMP CONDITION ETC <br /> Intact I Broken* _ CYl�Y2�— Z <br /> r <br /> 2 Custody Seal# Put in Remarks L , <br /> Section ` <br /> t <br /> 3Cham-of-Custody Tele 1 Absent* �G C" 3 4 <br /> 1 �G,wti <br /> 4 Traffic Reports or <br /> Packing List Presen / <br /> p V <br /> 5 Airbill Airbill I StictDC- <br /> Present llbwD <br /> 6 Airbill# <br /> 7 Sample Tags se 1 Absent <br /> Sample Tags#s ist I Not Listed ZZ <br /> on Chain-of-Custody <br /> 8 Sample Conditionnta '/ Broken* <br /> Lea ing* <br /> 9 Does information on <br /> custody reports, traffic <br /> reports and sample <br /> tags agree? Ov No* <br /> 10 Proper Preservatives <br /> used Ye / No* <br /> 11 Date Rec at Lab 7,117Z <br /> 12 Time Rec at Lab 3D <br /> 13 Temp Rec at Lab <br /> .a <br /> V Circled, contact Protect Manager and attach record of resolution <br /> Page l of <br /> Revision 9110196 <br /> RCPTLOGi XLS <br />