FSS Shellfish monitoring programme - Sample Submission form
                                                         (Please circle required test below)
                                 TOXIN                                  E.COLI                        CHEMICAL CONTAMINANTS
                   Production Area:                                                 Site Name:      
                   Site Identification Number (SIN):                                POD number:     
                   Date of collection:                                              OS Grid Reference (e.g. NS1234 5678):
                                                                                    (actual location of sampling)
                   Time of collection: 
                   Name of Sampling Officer:     
                   Contact telephone number:                                        Species:     
                                                                                    Method of Collection for shellfish samples 
                   Verified sample                                                  (please tick):
                   Verified from shore                                              Hand raked                       Dredged
                   Unverified sample                                                Hand picked                      Dived
                   Reason for Verified from shore / Unverified:                     Other (please specify):
                   ..................................................
                   ..................................................               Sample stored prior to dispatch?
                   ..................................................               Yes               Temperature of storage (oC): …….
                   Sample from area pending                                                              
                   classification      
                                                                                     No                Duration of storage (hours): ……...
                   Resample
                                                                                    Any other Relevant Information (e.g. weather,
                                                    o
                   Seawater Temperature ( C):                                       tidal state etc. – Vessel name/PLN for Razor
                                                                                    sample):
                                                 o                         1
                   Sample temperature ( C), where required :
                   Date of last harvesting: .......................                  
                   Planned next harvesting: ...............................
                   Confirmed with Operator/Harvestor
                   Number of sample boxes remaining:
                                                                                         1             2             3             4            5+
                     1 where shellfish sample is collected dry from intertidal area, see shellfish sampling protocol
                     PLEASE ENSURE THAT COOL–PACKS ARE FROZEN BEFORE PUTTING IN SAMPLE
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