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— rllllllll� IIIIIt� IIIIIIIIIA W� l• �� <br /> t <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG A <br /> CLIE14T NAME Ca WORKORDER <br /> REC BY (PRINT) 1,Ktit DATE OF LOG-IN <br /> CIRCLE TIIE APPROPRIATE RESPONSE LAB <br /> SAMPLE DASH CONTAINER SAMPLE. DATE REMARKS <br /> 1 Custody Seal(s) Present 1 AbseiW # # CLIENT IDENTIFICATION DESCRIPTION MA1 RIX SAMP CONDITION (ETC-) <br /> Intact / B ken" <br /> P -1 1 Soo() 1l3 hg <br /> 2 Custody Seal # Put in Remarks _ z <br /> Seclion <br /> 3 Chain-of-Custody Preset 1 Absent' <br /> 4 Traffic Reports or <br /> Packing List Present Absent <br /> 5 Anbrll Air bill 1 SI _ iz:� - S <br /> Present AE�senl <br /> OPD <br /> � Arrnrll # i <br /> 7 Sample Tags reser Al�seirl <br /> Sample Tags #sIsle Not Listed <br /> earn-of-Custody <br /> 8 Sample Condition nla 1 Broken' / _s <br /> rny• <br /> 9 Does information on _6 t <br /> custody reports, traffic <br /> reports and sample <br /> tags agree? Ems)No* <br /> til Proper Preservatives <br /> used Ye / No* <br /> 11 Date Rec at Lab <br /> 12 Time Rec at Late <br /> 13 Temp Rec at Lab <br /> r <br /> if Circled, contact Protect Manager and attach record of resolution { t <br />