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SEQUOIA ANALYTICAL-MPLE RECEIPT LOG <br /> k< II n <br /> CLIENT NAME C h e✓ron �� S, A WORKORDER gboze roq <br /> ;> REC BY (PRINT) �p S _ _ DATE OF LOG-IN r4` r y 61CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DASH CLIENT CONTAINER SAMPLE DATE REMARKS <br /> 'J' 1 Custody Seal(s) Present Absen # IDENTIFICATION DESCRIPTION MATRIX SAMP CONDITION ETC <br /> 2 4C 3� %/OAm <br /> xk Intact 1 Broken* A4i> ► <br /> E 2 Custody Seal Nos Put In Remarks Section D E <br /> :LC2) vu+as <br /> �{ 3 Chain-of-Custody 8 W1VJ <br /> i re !Absent"Records a .L <br /> L�) <br /> { 4 Traffic Reports or d A. � � <br /> { Packing List Present A sent e p <br /> z <br /> €� 5 Airbili Airbili/Sticker CIA _ A t,% <br /> z PresentAbsen <br /> i <br /> # 6 Airbili No <br /> $k <br /> € 7 Sample Tags emse1 Absent* <br /> Sample Tag Nos Not Listed <br /> on Chain-of-Custody IL <br /> i <br /> iY 8 Sample Condition Intact Broken*1 Leaking* <br /> I 9 Does information on custody <br /> `2 y <br /> reports, traffic reports and <br /> sample tags agree? Yes No* <br /> g 10 Proper preservatives <br /> used Yes No* <br /> 11. Date Rec at Lab <br /> �1 12 Temp Rec at LabB� <br /> <213 Time Rec at Lab, 4 <br /> tx _17711 v { 22 { } {, , L/ ♦ SN t ti { { 1, <[, <br /> * if Circled, contact Project manager and attach record of resolution <br /> Revision 3121195 <br /> Page of <br />