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Figu re 1<br />

SAMPLE CHECK-IN LIST<br />

DateTme Received: d 3 51 Sc'k W uOb/^2 S<br />

Work Order Number.<br />

0^<br />

Shipping Container ID: '^ ^ Chain of Custody #<br />

SAF # 13 I JGG-QP<br />

RFSH-SOW-93-0003<br />

Revision 5<br />

1. Custody Seals on shipping container inta ct? Yes ( q-,K o<br />

2. Custody Seals dated and signed? Yes (q- o<br />

3. Chain-of-Custody record present?^ Yes ( o ( ]<br />

4. Cooler temperature<br />

5. Vermicurde/packing mate ri<br />

als is Wet (] D ry<br />

6. Number of samples in shipping container.<br />

7. Sample holding times exceeded? Yes [I No 14--'<br />

8. Samp have:<br />

tape _hazard labels<br />

custody seals !approp riate sample labels<br />

9. Samp are:<br />

ii^n good condition leaking<br />

broken have air bubbles<br />

10. Where any anomalies identified in sample re ceipt? Yes [ I No [q--^<br />

11. Descrip tion of anomalies (in cl<br />

ude sample numbers):<br />

Sample ate: 6<br />

Telephoned<br />

?4<br />

G.

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