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■ri � w■■ ate■ r, � tl!• � : � ttttttt!• Ittttttttt� tt!• Itttttttttt� � tttttttttt� � Ittttttttt� <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIEN F NAME ����- WORKORDER <br /> REC BY (PRINT) T(,,, i1 DATE OF LOG-IN Z ""i ��y <br /> URCLE THE APPROPRIAIE rRESPOI)SE LAB <br /> SAMPLE DASII CONTAINER SAMPLE DATE REMARKS <br /> j 1 Custody Seal(s) PresentI)se& # It CLIENT IDENTIFICATION DESCRIPTION MATRIX SAMP CONDITION (E1C } <br /> Intact 1 Broken" \ <br /> S�' I -� �, � z�L4�`1�` <br /> 2 Custody Seal # Put rn Remalks p <br /> Section 11 S Z �7� J L U <br /> 3 Chanl-or-Custody Pies_ sJt I Absent* 3 r p2- 1) E, r <br /> 4 Traffic Reports or --- <br /> Packing List PresentAbsen ' <br /> 5 Aubill Anb[ll 1 Sticker <br /> Present /6FF)sen <br /> 6 Air bill # <br /> 7 Sample Tags PreI 1 Absent / <br /> Sample Tags #s Isle '1 Not Listed c <br /> on Chain-or-Custody <br /> ti <br /> 8 Sample Condition ntatT/ Broken'/ <br /> Celli <br /> 1 <br /> 9 Does information on <br /> custody reports, Traffic <br /> reports and sample <br /> tags agree? e 1 No* <br /> 10 Proper Preservatives <br /> used I No" <br /> 11 Date Rec at Lala <br /> 12 Time Rec at Lab <br /> 13 Temp Rec at Lab <br /> r7 L <br /> "It Circled, contact Project Manager and attach record of resotullon <br /> Revision 6118/97 Page of <br /> �_ <br />