Chain Of Custody Form
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1Chain of Custody Form
GBF Lab must have prior knowledge of your arrival with sample.
Confirmed Sample Drop-off with
Sampler Name
Sampler Signature
Date Sample Collected
Sample Source: Recreational Waters
Other Waters
(please specify)
Site ID and Description
Time Sample Collected
Number of Samples
Place sample on ice immediately. Deliver to the Lab within 6 hours of sampling.
Field Data
Air Temperature
Algae Cover
Present Weather
°
(
C)
Water Temperature
Water Color
Days Since Last Significant
°
Precipitation (runoff)
(
C)
Dissolved Oxygen
Water Clarity
Rainfall Accumulation
(mg/L)
(last 3 days)
pH
Water Surface
Sample Depth
(meters)
Water Transparency
Water Conditions
Salinity
(meters)
(ppt)
Total Depth
Water Odor
Tide Stage
(meters)
Laboratory Use Only
Sample
Sample
Comments:
Number:
Condition:
Volume
Analytical
Analyzed:
Method:
Relinquished By:
__________________________________
Date / Time: ______________________________
Received By (Lab): __________________________________
Date / Time: ______________________________
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