Chain Of Custody Form Page 2
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9000 Commerce Parkway, Suite B
Mount Laurel, NJ 08054
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Phone: 877-428-4285/856-231-9449
Fax: 856-231-9818
Sample Log
–Mold / Fungal Analysis–
Client: ____________________________________ Project_____________________________________
Mold Sample Log
Client Sample
Sample Volune
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2
#
iATL #
Location/Description
or Area (units)
Notes/Conditions
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Description includes sample matrix. Location should include general area of country (see below).
Matrix:
Air Non-Viable_____ Air Viable ______ Tape______ Swab_____ Bulk______ Contact Plate______ Other_______
Location:
Inside_________
Outside __________
Basement ___________ Other ________________________
2
Evaluation of Mold/Fungal Spore Samples may be aided by detailed observations and documentation of sampling conditions.
Weather:
No Precipitation ______ Light Precipitation______ Moderate Precipitation______ Heavy Precipitation___________
No Wind ____________ Light Wind ___________ Moderate Wind ___________ Heavy Wind ________________
Date/Time:
_______________AM / PM
o
o
Temperature:
_______________
C /
F
Relative Humidity: _______________%
RH Area /General: _______________(ex. Mountains)
Celebrating 25 years…one sample at a time
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