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0 • ! <br /> SEQITOXA AiNAMYTICAL SAMLE RECEPT LOG <br /> F��f'IE;�!'1"rirr jt DATE Received at Lzb. ;� �lrirxkia�mater for BV_ fF LTHT} "26-4 Received at Lab / _ rebulstory purposes- YES/ Q <br /> $ WOR KOitMM 1 O LOG 1V DA'Z'E: <br /> 13S-J .. �'Vastev►ester for <br /> regulatory pu.�poses YES/ O <br /> CIRC'Z.E TIM APZ'ROEItIATE RE.SZ�O:iS E SAT# VACONT+4 M SA. LPLE DATE � . <br /> S.4�1'fPLE# #� ! CY. ri'T ID ESCR PTICN MATRIX SA,�PLED CO�DfI'ION TC. <br /> ! Custody caps) des vow-, L <br /> Ir taco I Bmkcn* r"2 <br /> Cham -CusUod resc:t Absm4* 1}+� <br /> F 3 Trak epom or r <br /> Packmg L= Present Absca. ` <br /> 4. Ar1r1l Ai:b�/Sack: , <br /> �r�€errt 'oscat ��S <br /> S. A�rBr1] � YY1VJ'� <br /> 6 Sample Labcls �Absent y <br /> 7 Sample IDs Not L sme- <br /> an -0f�rstad <br /> S St�l:ply Condrtaon � :akan�l � � f <br /> 9 Does m ormatron on <br /> ' cas!ody rcpm,t-.dric <br /> rgcm aad sxmp?a <br /> labeis rov 6yk I N Q* <br /> 10 Sa:rriple received%m In <br /> hold time. Xrs 'No* <br /> 11 Proper Preservatavcs � <br /> used Na"' <br /> 12 Temp Rm a Lab 4.&tel <br /> Is temp 4 1 2°C? e 1 Ko** <br /> (Acceptanc;range far samples:equi-ing t emW prm) <br /> xccPhor;(if any) MaRb J DFZi cm icer I WT no=1 , <br /> or Problem COC <br /> .r w w��-\" �r'Mr • r�u •1v w �\ rrr r r <br /> o EZeee�pt Log *T.f Circledd contact Fro ect Mans ex anal attach rec rd of resolution. <br /> tMdl <br /> 14n 2.3(12=2) <br /> Pmmon 2,1 {0411 M) Page aF <br />