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� � � � t• � ,Ahs <br /> --------------� � �f•, i•._....._.� � �r I•i � �� w■ <br /> SEQUOIA ANALYTIC ME'LE RECEIPT t OG <br /> CLIENT NAME: `� �C�4 Cr,� WORKORDER q <br /> REC BY (PRINT) DAI E OF LOG-IN <br /> > CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DASI I CLIENT CONTAINER SAMPLE DATE REMARKS <br /> 1. Custody Seal(s) Present! sen # It IDENTIFICATION DESCRIPTION MATRIX SAMP. CONDITION ETC <br /> f Intact 1 Broken <br /> } 2 Custody Seal Nos : Put In Remarks Section <br /> { 3 Chain-of-Custody 5- �- <br /> Records. osePit Absent* u_C �• <br /> { 4 Traffic Reports or <br /> Packing List Present 6SESe5 <br /> .Sr Sr <br /> 5 Airbill Airbill I Slicker <br /> Present57 <br /> 6 Airbill No . <br /> 7 Sample Tags, Q esan Absent" <br /> s# <br /> t Sample Tag Nos : s e -7 Not Listed �b^- <br /> on Cllain-of-Custody <br /> ki 8 Sample Condition. Y Broken"1 Leaking" <br /> 9 Does Information on custody <br /> z3 reports, traffic reports and _r ~ S S <br /> :i sample tags agree? L� No" <br /> 10 Proper preservatives — <br /> >i used: (5e No" 2d. <br /> Y <br /> 11, Date Rec at Lab AzzTr <br /> 3' <br /> Y, 12 Temp. Rec at Lab: ~' <br /> ii <br /> 13 Time Rec at Lab <br /> <h h{4 < <br /> hhr5;i h,+„i,{ q (h{ .{v h, ,h{h s{{+xVh♦ h{ {i` h.{ { h c+ v +"{ { <br /> If Circled, contact Project manager and attach record of resolution <br /> Revision 3121195 <br /> Pape of <br />