RI DEM ER Chain of Custody Form by cni12242

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									                             RI DEM ER Chain of Custody Form                                                                                SAMPLE PARAMETER


INCIDENT ___________________________________             CASE NUMBER ________________


SAMPLER ____________________________             WITNESS ____________________________


PACKED BY ________________________________________________________________
                                                              M     C                       G
  DATE/TIME        SAMPLE                    CONTAINER        A
                               QUANTITY       TYPE AND        T     O                       R
  SAMPLED        ID NUMBER                  PRESERVATIVE      R     M                       A
                                                  *           I     P                       B
                                                              X
                                                              *




TOTAL NUMBER OF CONTAINERS:

*Container Type and Preservative Codes: P = Neutral Plastic; N = Nitric Acid Preserved; C = Sodium Hydroxide Preserved; J = Solvent Washed Acid Rinsed Jar; S = Solvent Washed Acid Rinsed Glass Bottle;
VC = Hydrochloric Acid Preserved Vial; VS = Sulfuric Acid Preserved Vial; BS = Sulfuric Acid Preserved Glass Bottle; Z = Zinc Acetate Preserved Bottle; E = EDTA Preserved Bottles; ST = Sterile Bottle; O =
Other
*Matrix Codes: A = air; GW = Groundwater; SE = Sediment; SO = Soil; SW = Surface Water; W = Water (Blanks); O = Other (specify)




 RI DEM ER Chain of Custody Form                                                                                                                                             RI DEM ERP 4-2-3, p. 1
    SAMPLE        RELINQUISHED BY   DATE/TIME   RECEIVED BY   DATE/TIME    SEAL    COMMENTS
  ID NUMBER                                                               INTACT




REMARKS




 RI DEM ER Chain of Custody Form                                                        RI DEM ERP 4-2-3, p. 2

								
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