U.S. Geological Survey, Woods Hole Science Center

Archival Policies and Collections Database for the Woods Hole Science Center's Marine Sediment Samples 2007, Version 1.0

Chain of Custody Form

Sample Number: _____________

Collecting Scientist: __________________

Field Activity Number: ______________

Purpose for Sampling:

___	research
___	identification
___	other: ___________________________________________________

Custody of Samples is given to:

Name, title	___________________________________________
Institution	___________________________________________
Address	___________________________________________
City, State, zip	___________________________________________
Phone	_____________________
Email	___________________________________________

Approved by:

_________________________________________________________________________________
Core Curator Signature and Date

_________________________________________________________________________________
Chief Scientist Signature and Date

_________________________________________________________________________________
Borrower Signature and Date

Description of samples taken: locations of sampling and all alterations made to the sample(s):

1.	Amount Taken _______________ grams Location of Sampling _______________ Section
2.	Amount Taken _______________ grams Location of Sampling _______________ Section
3.	Amount Taken _______________ grams Location of Sampling _______________ Section
4.	Amount Taken _______________ grams Location of Sampling _______________ Section
5.	Amount Taken _______________ grams Location of Sampling _______________ Section

For more than five (5) samplings, multiple forms must be completed

U.S. Geological Survey
Woods Hole Science Center
384 Woods Hole Road
Woods Hole, MA 02543