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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME pG WORKORDER r �V�-�4 <br /> REC BY (PRINT) I.k4-6 DATE OF LOG-IN <br /> CIRCLE THE APPROPRIATE RESPONSE LAB <br /> SAMPLE DASH CONTAINER SAMPLE DATE REMARKS <br /> 1 Custody Seal(s) Present 1 Abse # # CLIENT IDENTIFICATION DESCRIPTION MATRIX SAMP CONDITION (ETC) <br /> Intact 1 B ken" — 2l3}4 <br /> PD -1 D -1 � Sort o x <br /> 2 Custody Seal # Put in Remarks - 2 <br /> Section <br /> - 3 <br /> 3 Chain-of-Custody Prese 1 Absent" <br /> 4 Traffic Reports or <br /> Packing List Present Abs <br /> 5 Airbill Airbill / Sl S <br /> Present Absent OPD <br /> 6 Alrbill # Pp_ <br /> 7 Sample Tags reser Absenl _Z <br /> Sample Tags#s is e 1 Not Listed <br /> ialn-of-Custody <br /> 8 Sample Condition / Broken" / _5 <br /> Ing" <br /> 9 Does Information on <br /> custody reports, traffic <br /> reports and sample <br /> tags agree? Yes No' <br /> 10 Proper Preservatives + <br /> used Ye 1 No" t <br /> 11 Date Rec at Lab /1-7 <br /> 12 Time Rec at Lab + D-C <br /> 13 Temp Rec at Lab 5`G <br /> "rf CirclAWontact Project Manager and altach record of resolution <br /> � �,.,...,�> � ri■� r■■ia � �� � tIs r�� � �r ri_ rr� � Pae of <br />