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� ie� I� iiiiiiil� illlit� t� 1• -- � � -�-�� � t• f• � � li, � � <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT 14AME `7p 5e_,' WORKORDER <br /> REC BY (PRINT) f"`IV DATE OF LOG-IN <br /> CIRCLE IHE APPROPRIATE RESPOIJSE LAB <br /> SAMPLE DASII CONTAINER SAMPLE DATE =CONDITION <br /> S <br /> 1 Custody Seal(s) Present 1 bsenr # # CLIEN I IDENTIFICATION DESCRIPTION MATRIX SAMP (ETC ) <br /> Inlac.t 1 B ( [I <br /> T-- L'cW� 50cl o Z �t 141 <br /> Z Custody Seal # Put in Remarks <br /> Section <br /> 3 Chaw-of-Cuslody reser, 1 Absent` �' l <br /> 4 Traffic Reporls or <br /> Packing List Present 1 G,en <br /> 5 Airblll Alibill / Sticker <br /> Present GT 3 <br /> 6 Airbill# ------- --, GU <br /> 7 Sample Tags iesei 1 Absent ^ �C <br /> Sample Tags #s ise 1 Not Listed <br /> iiam-of-Custody <br /> 8 Sample Conditron nl 1 Broken' / <br /> knig• <br /> 9 Does Information on <br /> custody reports, traffic <br /> reports and sample <br /> lags agree? (Ye / No' <br /> 10 Proper Preservatives <br /> used 1 No' <br /> 11 Date Rec at Lab Z' h <br /> Q Time Rec at Lab 13 �a <br /> L13 Temp Rec at Lab <br /> 'If Circled, contact Project Manager and allach record of resolution, <br /> Page � of <br />