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SEQUOIA ANAL AL SAMPLE RECEIPT LOG <br /> CLIENT NAME 6 1 i WORKORDER <br /> REC BY (PRINT) DATE OF LOG-IN <br /> CIRCLE THE APPROPRIATE RESPONSE LAB <br /> SAMPLE DASH CONTAINER SAMPLE DATE REMARKS <br /> 1 Custody Seal(s) Present 1 Q6efli_ # # CLIENT IDENTIFICATION DESCRIPTION MATRIX SAMP CONDITION (ETC ) <br /> Intact/Broken* MW <br /> L Z,I <br /> 2 Custody Seal# Put in Remarks <br /> Section r <br /> 3 Cham-of-Custody &erFt 1 Absent* <br /> 4 Traffic Reports or <br /> Packing List Present! sen <br /> i <br /> 5 Airbill Airbill 1 Sticker <br /> Present/ ent <br /> 6 Airbill # / <br /> 7 Sample Tags �t/Absent I �i <br /> Sample Tags#s 1 Not Listed t <br /> on Cham-of-Custody <br /> 8 Sample Condition 1 Broken*1 <br /> �xgfing* y I <br /> i <br /> i <br /> 9 Does information on <br /> custody reports, traffic <br /> reports and sample <br /> tags agree? Ce`/No* <br /> ,10 Proper Preservatives <br /> used e1 No* <br /> 11 Date Rec at Lab �' �'r • <br /> 12 Time Rec at Lab act <br /> br <br /> 13 Temp Rec at Lab <br /> a <br /> *if Circled, contact Project Manager and attach record of resolution <br /> Revision 6148197 Page of <br /> SCFORMS XLS <br />