Chain of Custody-Fillable

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					                                                                         CHAIN OF CUSTODY FORM
NIAGARA ANALYTICAL LABORATORIES INC.                                                                                 In-Lab Job#:                                   Specify TAT req'd
5805 Progress St., P.O. Box 205                                                                                      Reporting time req'd:     Regular Turnaround
Niagara Falls, Ont. L2E 6T3                                                                                                                    Rush Turnaround
Laboratory Contact: Steph Johnson; Managing Director
phone:         905-374-LABS
fax:           905-356-9672
email:         labs@bellnet.ca
Company/Project Name:                                                            PO# / Project Ref# / other details relevant to lab analyses or invoicing:
Street Address & PO Box:
City/Town:
Province:
Postal Code:
Contact Person(s):                                                               Phone#:                 Fax#:                     email address:

Comments/Irregularities observed at sample collection time and/or sample check-in time:

                                                                                                      TESTS REQUIRED (please mark with an "X")
    In-Lab                            In-Field Sample        Date      Time                                                                                             NOTES
   sample#                              Identification     collected collected




Collected in-field by:                                     date       time       Relinquished by:                                                            date   time

Relinquished by:                                           date       time       Relinquished by:                                                            date   time

Relinquished by:                                           date       time       Received in laboratory by:                                                  date   time



filename: MSE-Chain of Custody-Fillable

				
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