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s ■� i� � t• � l� � Illi t� li I• li � � ltd <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME l WORKORDER GS -it 9 <br /> REG 13Y (PRINT) DA FE OF LOG-IN 'A �r <br /> I <br /> CIRCLE IIiE IIPPROPRIAIE RESPOIISE LAB <br /> SAMPLE DASII CONTAINER SAMPLE DATE REMARKS <br /> 1 Custody Seal(s) Present bsent, # # CLIENT IDENTIFICATION DESCRIPTION MATRIX SAMP CONDITION (ETC ) \ <br /> Intact / Broken" <br /> 2 Custody Seat # Put In Remaiks <br /> Secilorl <br /> 3 Chani-of-Custody Absent' <br /> 4 Traffic Reports or ��--- � - ----~ -- - — <br /> Packing List PresentAbsen <br /> 5 Aiibill Anbill / Sticker <br /> Present /kA seri <br /> 6 Ati bill # <br /> 7 Sample TagsPre�I I Absent <br /> Sample Tags #s Iste F/ Nol Listed c <br /> oft Chain-of-Custody �,` <br /> 8 Sample Condition titalml Broken" I <br /> Lea irrg' �J <br /> 9 Does information oil <br /> custody reports, traffic <br /> reports and sample <br /> lags agree? 0119o' <br /> 10 Proper Preservatives <br /> used Yep/ No" <br /> 11 Date Rec at Lab <br /> 12 Time Rec at Lab 1t-1� <br /> 13 Temp Rec at Lab �- <br /> V Circled, contact Project Manager and attach record of resolution <br /> Page of <br /> Revision 6/18197 <br />