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Figure 1<br />

SAMPLE CCK-IN LIST<br />

Date/TlmeReceived: ^^ ^^^^^ SG#:<br />

Work Order Number. 0 ^3 7<br />

r<br />

RFS H-SOW-93-0003<br />

Revision 5<br />

^ ^^0^ SAF #: oU^i -<br />

Shipping Container lD: O) Chain of Custody # /^0 "(',&/-<br />

1. Custody Seals on shipping container intact? Yes eNo<br />

2. Custody Seals dated and signed? Yes KNo [ ]<br />

3. Chain-of-Custody record present? Yes [>r No [ ]<br />

O<br />

4. Cooler temperature<br />

5. Vermiculite/packing mate rials is Wet [I Dn/^^<br />

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

7. Sample holding ti<br />

mes exceeded? Yes [ ] No [4---<br />

8. Samples have:<br />

_ Llape<br />

custody seals<br />

hazard labels<br />

appropriate sample labels<br />

9. Samp s are:<br />

n good condition leaking<br />

broken have air bubbles<br />

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

11. Desc ription of anomalies (include sample numbers):<br />

Sample Custodian/Labor/ UL ^^ Llj4<br />

Telephoned To: On C/<br />

I

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