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I <br /> SEQUOIA ANALYI ICA MPLE REGEiPT LOG <br /> CLIE14T NAME --J-p 5 C.' pC� � _ WORKORDER <br /> REG BY (PRINT) F-1K DA 1"E OF LOG-IN <br /> i <br /> CIRCLE IIIE APPROPRIAIE RES110IISE LAU <br /> SAMPLE DASII CONTAINER SAMPLE DATE REMARKS <br /> 1 Custody Seal(s) Present 1 bsent- # # CLIENT IDE14TIFICATION DESCRIPI ION MAI RIX SAMP CONDITION (EI C ) <br /> Inlacl / [3 t A jo C&, 50LI O <br /> 2 Custody Seal # Put In Remaiks <br /> Section u(i <br /> 3 Chaln-of-Cuslody resert /Absent" 0A T-1 —A- <br /> 4 Tfaflrc Reports or (,'L 75 <br /> Packing List Preseni / 3enl 0� G G 12 <br /> 5 A41bill Ali bill 1 Shf ker UL- Y _ <br /> Present ) t� I A <br /> 6 Alrbill # ------ ~ <br /> 7 Sample Tags reset I Absertl <br /> Sample Tags #s Isle 1 Not Lisled <br /> Italn-of-Cuslody <br /> 8 Sample Condition nl 1 Broken" 1 <br /> king" <br /> 9 Does information on l� <br /> custody reports, traffic <7 <br /> reports and sample <br /> tags agree? 6Ye" 1 No" <br /> 10 Proper Preservatives <br /> used / No" <br /> I I Date Rec M Lab 7i f S <br /> 12 Time Rec at Lab 13 �a <br /> 13 Temp Rec at Lala <br /> "lf Urcled, conlacl Project Manager and allaclt record of resolution r / <br /> D{ <br /> Revision 6118197 Page l r <br />