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t SEQUO11A ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME �3c��ch� "'4�' WORKORDER <br /> t REC BY (PRINT) tY� DATE OF LOG-IN <br /> � CIRCLE THE APPROPRIATE RESPONSE LAB <br /> SAMPLE DASH CONTAINER SAMPLE DATE REMARKS <br /> 1 Custody Seal(s) Present 1bsent # # CLIENT IDENTIFICATION DESCRIPTION MATRIX SAMP CONDITION (ETC ) <br /> Intact 1 tar P17 i 'a,-,_�s <br /> 2 Custody Seal# Put in Remarks 2 �� <br /> Section <br /> 3 Chain-of-Custody resent bsent" 3 r D)— C2 2 <br /> 4 Traffic Reports or tP Y 2 L S <br /> Packing List Present Kbsen <br /> 5 Airbill Airbill /Sticker <br /> Present !Absent <br /> 6 Airbill # V <br /> 7 Sample Tags ese I Absent <br /> i Sample Tags#s Listed Not Listed <br /> i hain-of-Custody <br /> 8 Sample ConditionInca token"1 <br /> along* <br /> 9 Does information on <br /> custody reports, traffic <br /> reports and sample <br /> tags agrees Yes 1 0" <br /> 16 Proper Preservatives <br /> usedYes No" <br /> 11 Dale Rec at Lab <br /> 12 Time Rec at Lab <br /> 13 Temp Rec at Lab <br /> If Circled, contact Project Manager and attach record of resolution <br /> _ Revision 6116!97 Page of <br /> RCPTLOG XLS <br />