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Figure 1
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Date/Time Received: `l
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RFSH-SOW-93 -0003
Revision 5
SAMPLE CHECX-W UST _ v
Work Order Number.
SAF S ^(j CzQ3 ^j ^j–(,^¢ 1 -
Shipping Container ID: "K-R .
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chain o(Qstody S ^g 3 Dot ^1 -09
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1. Custody Seals on shipping contairx intact? Yes [q/No ( I
2. Custody Seals dated and signed? Yes B-INo (1
3. Chain-of-Custody record present? Yes ( No (1
4. Cooler temperature l
o
5. VerrnicufdeJpacking mate ri
als is Wet [ Dry k/l )—
in
6. Number of samples shipping cadainer.
7. Sample holding times exceeded? 2« Yes No [
8. Samples have:
tape `hazard libels
_____custody seals _approprieie sample labels
9. Sam les are:
in good condition Ong
broken Inge air bubbles
10. Where any anomalies iden tified in sample receipt? Yes (j No
11. Descrip ti
on of anomalies (include sample numbers:
Telephoned To: On gy
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