Chain Of Custody & Sample Information Record
ADVERTISEMENT
1E.S. Babcock & Sons, Inc. Environmental Laboratories
Chain of Custody & Sample Information Record
(951) 653-3351 FAX (951) 653-1662
Client:
Contact:
Phone No.
Additional Reporting Requests
FAX No.
Email:
Include QC Data Package:
Yes
No
FAX Results:
Yes
No
Project Name:
Turn Around Time:
Routine
*3-5 Day
*48 Hour
*24 Hour
Email Results:
Yes
No
Rush
Rush
Rush
State EDT:
Yes
No
Project Location:
*Lab TAT Approval:
*Additional Charges May Apply
By:
(Include Source Number in Notes)
# of Containers
Sample
Sampler Information
Matrix
Notes
& Preservatives
Type
Analysis Requested
Name:
DW = Drinking Water
WW = Wastewater
Employer:
GW = Groundwater
S = Soil
Signature:
SG = Sludge
L = Liquid
Sample ID
Date
Time
M = Miscellaneous
Relinquished By (sign)
Print Name / Company
Date / Time
Received By (Sign)
Print Name / Company
(For Lab Use Only)
Sample Integrity Upon Receipt
Lab Notes
Temperature
Lab No.
Sample(s) Submitted on Ice?
Yes
No
°C
Custody Seal(s) Intact?
Yes
No
N/A
Page
of
Sample(s) Intact?
Yes
No
Cooler Blank
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal