Downloads

Chain of Custody (non-fill-able format)

Chain of Custody (fill-able format)

 

Instructions for filling out the Chain of Custody

The chain of custody can be printed out and filled in black ink (NonFillableCoC.pdf) or typed with our FillableCoC.pdf. Carbon-copy chain of custody forms are also available at our lab.

Please fill out the client information, including:

  • Client Name (required)
  • Email (optional)
  • Address (required)
  • Project Name (optional)
  • Project Number (optional)
  • P.O. Number (optional)
  • Project Manager
  • Phone Number
  • Fax Number
  • Sampler Name
  • Sampler Signature
  • TAT (Analytical Turn Around Time)
  • Analyses Requested

For each Sample:

("Sample No." is for lab use)

  • Date Sampled
  • Time Sampled
  • Sample Description (you may include your sample number here)
  • Matrix (Water or Other)
  • Container (Qty., type, Grab/Comp)
  • Analysis (Check box)

If using multiple pages, you may indicate so on the top right of the page.

Special instructions may be indicated on the bottom of the page.

Please sign under Relinquished by and Received by as necessary.

Please contact us if you have any questions.