New Jersey Chain Of Custody
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1Service Centers
NEW JERSEY
Page
Date Rec'd
Mahwah, NJ 07430: 35 Whitney Rd, Suite 5
CHAIN OF
ALPHA Job #
of
Albany, NY 12205: 14 Walker Way
in Lab
Tonawanda, NY 14150: 275 Cooper Ave, Suite 105
CUSTODY
Westborough, MA 01581
Mansfield, MA 02048
Deliverables
Billing Information
Project Information
8 Walkup Dr.
320 Forbes Blvd
NJ Full / Reduced
Same as Client Info
TEL: 508-898-9220
TEL: 508-822-9300
Project Name:
FAX: 508-898-9193
FAX: 508-822-3288
EQuIS (1 File)
EQuIS (4 File)
PO #
Project Location:
Other
Client Information
Project #
Regulatory Requirement
Site Information
Client:
(Use Project name as Project #)
Is this site impacted by
SRS Residential/Non Residential
Address:
Project Manager:
Petroleum?
Yes
SRS Impact to Groundwater
ALPHAQuote #:
NJ Ground Water Quality Standards
Petroleum Product:
Phone:
Turn-Around Time
NJ IGW SPLP Leachate Criteria
Fax:
Standard
Due Date:
Rush
(only if pre approved)
Other
Email:
# of Days:
T
ANALYSIS
Sample Filtration
These samples have been previously analyzed by Alpha
o
For EPH, selection is
For VOC, selection
Other project specific requirements/comments:
t
Done
REQUIRED:
is REQUIRED:
a
Lab to do
l
Preservation
Please specify Metals or TAL.
Category 1
1,4-Dioxane
Lab to do
B
Category 2
8011
.
o
(Please Specify below)
t
t
Collection
ALPHA Lab ID
Sample
Sampler's
Sample ID
l
(Lab Use Only)
(
y)
Matrix
Initials
Date
Date
Time
Time
Sample Specific Comments
Sample Specific Comments
e
e
Preservative Code:
Container Code
Westboro: Certification No: MA935
Please print clearly, legibly
Container Type
A = None
P = Plastic
and completely. Samples can
Mansfield: Certification No: MA015
B = HCl
A = Amber Glass
not be logged in and
C = HNO
V = Vial
3
G = Glass
Preservative
turnaround time clock will not
D = H
SO
2
4
B = Bacteria Cup
start until any ambiguities are
E = NaOH
C = Cube
F = MeOH
resolved. BY EXECUTING
Relinquished By:
Date/Time
Received By:
Date/Time
O = Other
G = NaHSO
THIS COC, THE CLIENT
4
E = Encore
H = Na
S
O
HAS READ AND AGREES
2
2
3
D = BOD Bottle
K/E = Zn Ac/NaOH
TO BE BOUND BY ALPHA'S
O = Other
TERMS & CONDITIONS.
(See reverse side.)
Form No: 01-14 HC (rev. 30-Sept-2013)
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