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SEQ 01AIANALK WAUMMINWRE EIQT LOO <br /> I ' I 1" i1�E i II <br /> TVwM:Z 77777w. <br /> CLIENT NAME f3lL teiR P*ORt�F <br /> i I <br /> REC BY(PRINT) DATE OF LOG- <br /> CIRCLE THE APPROPRIATE RESPONSE LAB 1 I <br /> SAMPLE DASH l� (CONTAINER SAMPLE DATE REC�I/�RIKS ;'s' <br /> 1 Custody Seal(s) Present(rAoies <br /> e ' # I# I CLIENT IDENTIFICATION : DESCRIPTION MATRIX SAMP CONDITION ETC( <br /> Intact 1h* I " <br /> I , , 4 I <br /> 2 Custody Seal# Put in Remarks <br /> Section <br /> ft I I <br /> Chain-of-Custody nese 1 Absent* ! <br /> Itaff�c Reports or i ! <br /> 'tiI cking List Present Absent " ' <br /> l <br /> i <br /> II ifAElrbill Alrblll l Stic ( ` <br /> Present 1 bsen <br /> 6 Airblll # ' <br /> I ' <br /> I ' <br /> 7 Sample Tags reser I Absent <br /> Sample Tags#s is /Not Listed <br /> I on Chain-of-Custody r <br /> 8 Sample Condition /broken*/ <br /> eaking* s <br /> 9 Does Information on <br /> custody reports, traffic <br /> reports and sample <br /> tags agree? es I No* i <br /> I iW ProperlPreservatives <br /> used es No* <br /> � I <br /> 11 Date Rec at Lab l z'30• Z <br /> I Z <br /> E <br /> ;12 Time Rec at Lab A0 3� ! <br /> I <br /> 13 Temp Rec at Lab <br /> I <br /> I <br /> w, r w �5 vim* ra +> v. w +y++•}v. rr^ r^� +�*r r .c r�fi +� r nr r>r>+^r r k�,r � wr n <br /> if Circled,,contact Prolgct Manager and attach record of r�sp(y�( <br /> Revision 6118197 <br /> I' <br /> SCFORNISXLS i <br /> I I,IIE.i I <br /> ip <br />