| Record the client name, address,
contact, and a phone and fax number where the client contact can be reached in case of
questions. Project ID/Description: Record the
name of the project or client/site location, and the project number as assigned by the
field team. (example-613215;x,y,z Chemical Co., WA).
P.O.: Record a purchase order number for billing and
reference purposes.
Sample Matrix: Use one (1) chain-of -custody record
per sample matrix. Circle the matrix which most accurately represents the samples included
on the C-O-C, (i.e. water, soil, oil, sludge). For multiphasic samples (e.g. oil and
water), or a non-listed matrix, circle "other" and describe the matrix in the
space provided.
Date and Time Collected: Record the date and exact
time each sample was collected. Use 24 hr. clock.
Client ID: List the complete identifying name/number
of each of the samples you send. These ID's must correspond with the identifying labels on
the sample containers.
Number of Containers: Indicate the number of
containers being shipped for the respective samples.
Test Requested: In the vertical spaces denoted
"Test Requested", indicate all method numbers for which the samples will be
analyzed.
Comments: The comments section can be used to record
the waybill or air bill number if the samples are being sent by a shipping company, any
special instructions to the laboratory regarding the processing of the samples or an
indication if the samples are suspected to contain high concentrations of any hazardous
materials.
Signatures: When releasing custody of these samples,
use the "Relinquished By" space to sign your full name, date, and time released.
After verifying that all samples indicated are present, the person receiving the samples
will sign in the "Received By" space to take custody of the samples.
All other sections of the C-O-C record are for
Analytica use, and should be left blank. |
