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Oate/7me Received:<br />

Figure 1<br />

SAMPLE CHECK4N LIST<br />

~ ! ^^ I S Ll SGS Li ln Z^7S<br />

(j<br />

Work Order Number. ^1 ^^^^^L'^^^ SAF<br />

RFSH-SOW-93-0003 -<br />

Revision 5<br />

Shipping Container 1 0: 51)1 90 Chain ofCustody # ^ 7^^ ^ – ^L ^ ^^^o ^ L ^<br />

1. Custody Seals on shipping container intact? Yes [ ] No ( ^<br />

2. Custody Seals dated and signed? Yes [ ] No [ 11^<br />

3. Chain-of-Custody record present? Yes W N or( ]<br />

4. Cooler temperature l<br />

L)<br />

S. Vermiculite/packing mate rials is Wet [ ] t ry (I<br />

6.<br />

Number of samples in shipping container.<br />

7. Sample holding times exceeded? Yes [I No (I<br />

8. Samples have:<br />

tape hazardlabe<br />

astcdy seals _appropriate sample labels<br />

9. Samples are:<br />

o good condition ­le akn9<br />

broken have air bubbles<br />

10. Where any anomalies identified in sample receipt? Yes [J'No [ ]<br />

11. Description of anomalies (include sample numbe#<br />

Sample CustodianlLaboratc ry: — L^_ ( a te: ^,<br />

Telephoned To: On gy<br />

I 'l

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