Environmental Chemistry Chain Of Custody
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1
2Environmental Chemistry
Chain of Custody
EMSL Order Number
:
(Lab Use Only)
P
:
HONE
F
:
AX
Report To Contact Name:
Bill To Company:
Company Name:
Attention To:
Street:
Street:
City:
State/Province:
Zip Code:
City:
State/Province:
Zip Code:
Phone :
Fax :
Phone:
Fax:
Project Name:
U.S. State where Samples Collected:
Number of Samples in Shipment:
Date of Shipment:
Purchase Order:
Sampled By (Signature):
E-mail
Mail
FAX
Please Provide results:
Email Results To:
Standard Turnaround Time:
2 Weeks
The following TAT’s are subject to lab approval:
1 Week
4 Days
3 Days
2 Days
1 Day
Failure to complete will hinder processing of samples
Matrix
Preservative
List Test(s) Needed
W=Water
1=HCL
S=Soil
2=HNO3
Date/Time
Client Sample ID
Comp
Grab
A=Air
3=H2SO4
Comments
SL=Sludge
4=ICE
O= Other
5=Other
Released By (Signature)
Date & Time
Received By
Date & Time
Please indicate reporting requirements:
Results Only
Results and QC
Reduced Deliverables
Disk Deliverable
Other
Instructions or Comments:
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