Chain Of Custody Record Page 2
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3Calgary: 4000 19th St. NE, T2E 6P8. Toll Free (800) 386-7247
CHAIN OF CUSTODY RECORD
Edmonton: 9331-48 St. T6B 2R4. Toll Free (800) 386-7247
Page
of
maxxam.ca
Same as CoC
Report Information
Comments
Analysis Requested
Company:
Contact:
Project/LSD
Phone:
Email:
Sampled by:
Time
Depth
Date Sampled
Sample Identification
Sampled
Matrix
Special Instructions
(Unit)
(YYYY/MM/DD)
(HH:MM)
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Please indicate Filtered, Preserved or Both (F, P, F/P)
Relinquished by: (Signature/ Print)
DATE (YYYY/MM/DD)
Time (HH:MM)
Received by: (Signature/ Print)
DATE (YYYY/MM/DD)
Time (HH:MM)
Maxxam Job #
AB FCD-00331/6
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