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b1=UUU1A ANALT I IGAL bAMNLE REUEIN I LUG <br /> CLIENT NAME <br /> � WORKORDER <br />` REC BY (PRINT) fAlm DATE OF LOG-IN <br /> CIRCLE THE APPROPRIATE RESPONSE LAB <br /> SAMPLE DASH CONTAINER SAMPLE DATE REMARKS <br /> 1 Custody Seal(s) Present/ ## # ' CLIENT IDENTIFICATION DESCRIPTION MATRIX SAMP CONDITION (ETC ) <br /> Intact I BOD <br /> 2 Custody Seal# Put in Remarks g <br /> Section <br /> 3 Chain-of-Custody (!ER/ <br /> Absent* C <br /> 4 Traffic Reports or D <br /> Packing List Present/ sent <br /> 5 Airblll Airblll 1 Stic1 13 <br /> bsent <br /> C <br /> 6 AlrbAl # Present/ <br /> 7 Sample Tags2Not <br /> Absent <br /> Sample Tags#s Listed <br /> on Chain-of-Custody <br /> 8 Sample Condition Int roken*1 <br /> Leaking* <br /> 9 Does information on <br /> custody reports, traffic <br /> reports and sample <br /> tags agree? es o* <br /> 10 Proper Preservatives <br /> used Yes No* <br /> 11 Date 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 f <br /> } Revision 6/18197 Page Of J <br /> RCPTOLS . 0 <br />