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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME <br /> WORKORDER y <br /> REC BY(PRINT) ._ DATE OF LOG-IN <br /> x CIRCLE THE APPROPRIATE RESPONSE LAB <br /> SAMPLE DASH CONTAINER SAMPLE DATE REMARKS <br /> Y 1 Custody Seal(s) Present/ bsent # # CLIENT IDENTIFICATION DESCRIPTION MATRIX SAMP CONDITION ETC <br /> Intact 1 Br <br /> 2 Custody Seal# Put in Remarks UV 0r <br /> x Section �- E <br /> 3 Cham-of-Custody res t 1 Absent" <br /> r <br /> 4 Traffic Reports or <br /> Packing List Present `Absen <br /> x � <br /> 5 Airbill Airbill /Stick <br /> Present 1 bsent Z <br /> r 6 Airbill# T <br /> k <br /> I <br /> 7 Sample Tags Eres:e 1 Absent <br /> Sample Tags#sListed Not Listed <br /> on ain-of-Custody <br /> { 8 Sample Condition tac /Broken*1 <br /> } Lea ing* <br /> z <br /> Y 9 Does information on �} <br /> custody reports, traffic <br /> reports and sample <br /> r tags agree? be /No* <br /> x <br /> x <br /> 10 Proper Preservatives <br /> used Ces)No* <br /> x <br /> ,11 Date Rec at Lab Z2 - , <br /> 12 Time Rec at Lab <br /> 13 Temp Rec at Lab <br /> 2 <br /> x _ <br /> if Circled, contact Project Manager and attach record of resolution <br /> Revision 7 Page f j <br /> r RCPTLCS . <br />