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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME 1 G WORKORDER <br /> REC BY (PRINT) DATE OF LOG-1N <br /> CIRCLE THE APPROPRIATE RESPONSE LAB <br /> SAMPLE DASH CONTAINER SAMPLE DATE REMARKS <br /> 1 Cuslody Seal(s) Present1e <br /> # # CLIENT IDENTIFICATION DESCRIPTION MATRIX SAMP CONDITION (ETC) <br /> Intact 1 B � �OLt X113�9g <br /> PD-1 n <br /> 2 Custody Seal # Pul in Remarks , 2 <br /> Section <br /> - 3 <br /> 3 Chain-of-Custody Prese 1 Absent" <br /> 4 Traffic Reports or 4 <br /> Packing List Present Abs I e t a <br /> w <br /> 5 Airbill Airbill 1 SI – 15 <br /> PresentAbsent V� Q <br /> 'J , <br /> 6 Airbill # <br /> ------------------- <br /> PP- 1 <br /> 7 Sample Tags reser Absent 2 <br /> Sample Tags #s is e 1 Not Listed ^ ' <br /> _ lain-of-Custody <br /> 8 Sample Condition nla / Broken*1 _s <br /> mg' <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 / No* 7� <br /> J � <br /> 11 Dale Rec at Lab ` 17 N <br /> 12 Time Rec at Lab + �� <br /> 13 Temp Rec at Lab JG-a G <br /> 'if Circle nlact Project Manager and attach record of resolution <br /> 7 i� fls� ■fir ■�� ■�■■� �■ A ...... ....rte — Page o f____�__- <br />