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SEQUOIA ANALYTIC MPLE RECEIPT LOG <br /> FJFR <br /> ENT NAME c <br /> PCS WORKORDER <br /> BY (PRINT) rri+Kc; DATE OF LOG-IN 7/11141 <br /> CIRCLE THE APPROPRIA IE RESPONSE LABif <br /> SAMPLE DASH CONTAINER SAMPLE DATE REMARKS <br /> 1 Custody Seal(s) Present 1 bsefft_ # # CLIENT IDENTIFICATION DESCRIPTION MATRIX SAMP CONDITION (ETC ) <br /> tnlact / B _ + <br /> 2 Custody Seal # Put in Remarks <br /> Section 4 1x1 - Zoe Ted G <br /> 3 Chain-of-Custody r 1 Absent" �i SE <br /> 4 Traffic Reports or <br /> Packing List Present 1 �6senl <br /> 5 Arrbill Airbitl 1 Sticker <br /> Presenll �efi <br /> 6 Airbill # -�- � <br /> 7 Sample Tagsreser /Absent <br /> Sample Tags#s Is(e 1 Not Listed <br /> hairs-of-Custody <br /> 8 Sarnple Condition j9) / Broken' <br /> 1 <br /> Qking« <br /> 9 Does information on <br /> custody reports, traffic <br /> reports and sample <br /> lags agree? 6Ye' /No* <br /> 10 Proper Preservatives <br /> used / No` <br /> 19 <br /> 1 1 Date Rec at Lab 7r/a (cf <br /> 12 Time Rec at Lab <br /> 13 Temp Rec at Lab <br /> "if Circled, contacl Project Manager and attach record of resolution <br /> Revlslon6/18/97 Page <br /> RCPTLOG XL5 <br /> i <br />