CytoCulture Environmental Biotechnology 249 Tewksbury Avenue Point Richmond, CA 94801-3829
CHAIN OF CUSTODY FORM
Project Name: Client Organization: Address to Send Results: Client Fax for Sending Data: Client Tel for Follow-up: Client Contact / Project Manager: Client Sampler / Recorder: Project No. Purchase Order / LOG IN #: Project Manager:
Sample ID
Sampling
Matrix
Bacterial Plate Enumerations Aerobic Anaerobic
Hydrocarbon Water Degraders Total Heterotrophs Hydrocarbon Degraders Total Heterotrophs
Bacterial MPN Enumerations Anaerobic
Nitrate Reducers Iron Reducers Sulfate Reducers
Nutrient / Chemical Assays
Date
Time
Soil
pH
mV DO
NH3
PO4
NO3
SO4 Sulfide Fe(II) Fe(III)
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Signature of this form constitutes
a firm Purchase Order for services.
Payment DUE on Reporting Date.
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Received for CytoCulture Lab by: Date/Hr:
CytoCulture Tel: 510-233-0102 Please fax Chain of Custody form Lab Services Fax: 510-233-3777 to CytoCulture prior to delivery.