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. SEQUOIA ANALYTICAL 5A HECEIPT LOG - <br /> MASTER LOG NO. ! PAGE: "TV <br /> CLIENT NAME. 0 X)0 - 0191,03) <br /> REC. BY. {PAINT): ,-- - -i DATE OF. LOG-IN: 2 <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DASH CLIENT CONTAINER SAMPLE DATE REMARKS: <br /> N IDENTIFICATION DESCRIPTION MATRIX SAIAP. CONDITION(ETC) <br /> 1. Custody Seal(s): Present sent ?- - �Q� <br /> Intact ! Broken' <br /> 2. Custody Seal Nos.:. <br /> C <br /> 3. Chaln-of-Cuslody Pres i Absent' 1- <br /> Records: <br /> GJv <br /> ! 4. 'Traffic Reports or Present <br /> Packing List: <br /> 5. Alrbill: Alrbill ! sliciiat <br /> Present / Ab enl <br /> 5. Alrb111 No.: �--1 <br /> 7. Sample Tags: ! Absent' <br /> Sample Tag Nos.: �elNot listed <br /> on hale-ot-Cuslody <br /> B. Sample Condition: nta IBroken'1Leaking* <br /> 9. Does Information on Yes I No' <br /> custody reporls,, traffic <br /> reparts and sample lags agree? <br /> 10. Proper ! No' <br /> Preservatives Used: Fn <br /> 11. Dale Rec. at Lab: Iq <br /> 12. Thne Rec. al Lab: 1. D� <br /> If Circled, contact Project Manager and attach record of resolution <br /> Form SC001 Page_',)—of Z <br />