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t e,<br />

CIO<br />

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

rJRevision 5<br />

Figu re 1<br />

SAMPLE CHECKA LIST<br />

Dat&Mme Received ! `1 r) Mt .. ()Oa).29'<br />

Work Order Number. bU3., I v^4a SAF #- _((^<br />

Shipping Cbntainer ID: w Chain atCustody I wIk-Q(^ / - /G<br />

1. Custody Seals on shipping contanrr intact? Yes I l<br />

2. Custody Seals dated and signed? Yes [ No (1<br />

3. Chain-d-Cuddy rec ord present? Yes No I 1<br />

• e ^<br />

4. Cooler terrmperatore<br />

5. Vermicufdelpadcrg materials is Wet [ j C ry 13<br />

6. Number of samples in shipping cmtainer. 1<br />

7. Sample holding fines exceeded? Yes [ J No ( j<br />

F Sa leshave<br />

custody seals<br />

hazard labels<br />

,appropriate sample labels<br />

9. -e6mples are:<br />

in good otindi5on<br />

leaking<br />

broken have air bubbles<br />

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

11. Description of anoma lies (include sample numbers):

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