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    Chain of Custody Form

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    nisce
    This document provides chain of custody information for water and soil samples being transferred from a client to a laboratory for analysis. It lists the client and address, job number, project name, sample site, sample types, bottles used for collection, analyses required, and spaces to document details of sample transfer including names of those relinquishing and receiving the samples, dates, times, and sample conditions. The document tracks up to 10 samples being sent for testing and provides fields to note any special comments or instructions.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Chain of Custody Form

    Uploaded by

    nisce
    37 views1 page
    This document provides chain of custody information for water and soil samples being transferred from a client to a laboratory for analysis. It lists the client and address, job number, project name, sample site, sample types, bottles used for collection, analyses required, and spaces to document details of sample transfer including names of those relinquishing and receiving the samples, dates, times, and sample conditions. The document tracks up to 10 samples being sent for testing and provides fields to note any special comments or instructions.

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    This document provides chain of custody information for water and soil samples being transferred from a client to a laboratory for analysis. It lists the client and address, job number, project name, sample site, sample types, bottles used for collection, analyses required, and spaces to document details of sample transfer including names of those relinquishing and receiving the samples, dates, times, and sample conditions. The document tracks up to 10 samples being sent for testing and provides fields to note any special comments or instructions.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    37 views1 page

    Chain of Custody Form

    Uploaded by

    nisce
    This document provides chain of custody information for water and soil samples being transferred from a client to a laboratory for analysis. It lists the client and address, job number, project name, sample site, sample types, bottles used for collection, analyses required, and spaces to document details of sample transfer including names of those relinquishing and receiving the samples, dates, times, and sample conditions. The document tracks up to 10 samples being sent for testing and provides fields to note any special comments or instructions.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    CHAIN OF CUSTODY DOCUMENTATION

    CLIENT: Samples Relinquished By:


    ADDRESS / OFFICE: Client / Samplers Name:
    JOB/QUOTE/PURCHASE ORDER No: Date and Time:
    PROJECT NAME: PHONE: Laboratory Contact
    SAMPLE SITE: EMAIL REPORT TO: Phone: (07) 5431 8855
    SAMPLE TYPE (Potable, effluent, creek etc): ANALYSIS REQUIRED e: [email protected]

    SAMPLE INFORMATION (note: S = Soil, W=Water) BOTTLE INFORMATION Comments / Instructions:

    Total
    Lab ID SAMPLE ID MATRIX DATE Time Codes (see below) bottles
    W
    W
    W
    W
    W
    W
    W
    W
    W
    Bottle Codes:
    Unitywater bottles: P = Unpreserved plastic, ST = Bacteriological, BL = black opaque, DS/TS = Dissolved/Total sulphides
    ALS bottles: AG = unpreserved (orange label), SP = sulphuric preserved (purple lable), NP = nitric preserved (red label), FP = Formaldehyde preserved (brown label), SH = Sodium hydroxide preserved (blue label), CS = Dust Deposition
    SAS/QUU bottles: AG = amber glass; 200AG-HAA = 200mL amber glass ammonium chloride preserved; GJ = glass wide mouth; 40GV = 40mL glass vial; 1LBP = 1L opaque brown plastic Lugols preserved; DUST = 4L amber glass
    Laboratory / Office Use Only
    RECEIVED BY: Frozen o SAMPLE CONDITION COMMENTS
    NCC Staff: Date: Chilled o
    Of: Unitywater Time: Room Temp o
    Sampling Officer Initial: Date: Warm o
    Of: Unitywater Laboratory Time: RECEIVED BY: Lims No.
    Sampling Officer - transport: Date: Lab Staff Initial: Date:
    Courier - transport: Time: Of: Unitywater Laboratory Time:

    Unitywater Laboratory COC Page 1 of 1

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