Chain of Custody Form

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					GeoLabs, Inc.                                             Turnaround Time                                        Page____of____
Environmental Laboratories                   RUSH:       24hrs            STANDARD:                      SPECIAL INSTRUCTIONS
45 Johnson Lane                                          48hrs                5 Days_____
Braintree, MA 02184                                      72hrs            Rush
Office:      781-848-7844                                                 Approved By:_____
Fax:         781-848-7811

Client:                                      Project Number:
Address:                                     Project Location:

Phone:
Fax:                                         Purchase Order #:
Contact:                                     Collected By:
E-mail:                                                                                                      ANALYSES REQUESTED
              COLLECTION                     CONTAINER




                                                                                                                                       TEMPERATURE
                       S
                                                     Q     M                                                                                         L
                       A                       T                 C   G    P
              D    T                                 U     A                     GEOLABS                                                             A
                       M
              A    I     B      SAMPLE         Y           T     O   R    R
SAMPLE ID     T    M
                       P
                         Y
                                                     A     R
                                                                                 SAMPLE                                                              B
                       L       LOCATION        P                 M   A    E
              E    E                                 N     I                     NUMBER                                                              p
                       E                       E                 P   B    S
                                                     T     X                                                                                         H
                       D




CONTAINER CODES:             MATRIX CODES:          PRESERVATIVE CODES:       Relinquished By:   Date/Time     Received By:       Date/Time:
A = Amber                    GW = Ground Water      1 = HCl     7 = ICE
B = Bag                      WW = Wastewater        2 = HNO3                  Relinquished By:                 Received By:
G = Glass                    DW = Drinking Water    3 = H2SO4
P = Plastic                  SL = Sludge            4 = Na2S2O3               Relinquished By:                 Received By GeoLabs:
S = Summa Canister           S = Soil   A = Air     5 = NaOH
O = Other   V = VOA          O = Oil   OT = Other   6 = MeOH                                  GEOLABS CHAIN OF CUSTODY

				
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posted:11/9/2012
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