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SEQUOIA ANALYTICAL OPLE RECEIPT LOG <br /> > CLIENT NAME f� WORKORDER <br /> t REC BY (PRINT) DATE Of LOG-IN - <br /> >< CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DASI-{ CLIENT CONTAINER SAMPLE DATE REMARKS <br /> 1 Custody Seal(s) Present 1 Absent # # IDENTIFICATION DESCRIPTION MATRIX SAMP CONDITION ETC <br /> Intact/ Broken* 1 I C�iI !O <br /> 1 2 Custody Seal Nos Put in Remarks Section 2 <br /> 3 Chain-of-Custody ' ' <br /> Records Present Absent* 31 <br /> Y <br /> 4 Traffic Reports or <br /> Packing List Present 1 Absent <br /> >; 5 Airbill Airbill/ sticoL, _ <br /> Present 1Absent ,3 <br /> #t 6 Airbill No r � <br /> I 7 Sample Tags Presen 1 Absent* I !�P <br /> Sample Tag Nos Lisl Not Listed (t <br /> s on Chain-of-Custody IZ Ef, <br /> 8 Sample Condition (Intal/Broken*1 Leaking* <br /> xa 9 Does Information on custody I� <br /> f{ reports, traffic reports and l5 <br /> sample tags agree? oYesNo* I <br /> { 10 Proper preservatives <br /> used CYDes1 No* l <br /> f i!!{ 1 I , <br /> �2 14 Dale Rec at Lab <br /> >> 12 Temp Rec at Lab <br /> 13 Time Rec at Lab ceq <br /> ' <br /> if Circled, contact Project manager and attach record of resolution <br /> Revision 3121195 <br /> Page_ ____of �' <br />