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SEQUOIA ANALYTICAL. S MPLE RECEIPT LOG <br /> CLIENT NAME p J WORKORDER �67, <br /> REC BY(PRINT) r .L DATE OF LOG-IN <br /> CIRCLE THE APPROPRIATE RESPONSE <br /> LAB SAMPLE ASH <br /> ! CLIENT CONTAINER SAMPLE DATE REMARKS <br /> 1 Custody Seal(s) Present Absent # # IDENTIFICATION DESCRIPTION MATRIX SAMA CONDITION ETC <br /> Intact l Broken* 2t r1 t,J -a 03v r�- S <br /> 2 Custody Seal Nos Put in Remarks Section <br /> 3 Chain-of-Custody <br /> x Records (DPresen !Absent* " s <br /> 4 Traffic Reports or <br /> ,i Packing List PresentAbsent <br /> J� r <br /> 5 Airbill Alrbill /Sticker 2�.. <br /> Present 1 A sent <br /> r 6 Airbill No <br /> ( 7 Sample Tags Prese t/Absent* <br /> : Sample Tag Nos is ed Not Listed <br /> zy on Chain-of-Custody 1 <br /> ' 8 Sample Condition ntac Broken*I Leaking* <br /> 9 Does information on custody <br /> $< reports, traffic reports and <br /> sample tags agree? Yes No* <br /> x. i <br /> i 10 Proper preservatives <br /> used (Yes 1 0* / <br /> 11 Dale Rec at Lab C)(0 <br /> f 12 Temp Rec at Lab 100c - <br /> 13 <br /> O°13 Time Rec at Lab <br /> * if Circled, contact Project manager and attach record of resolution <br /> Revision 3/21195 <br /> Page of `)— <br />