Form 302 - Chain of Custody - Client_ashley by nyb13813


									                                                            CHAIN OF CUSTODY - Client
                                                                             ENVIROLAB SERVICES
Client:                                                                           Client Project Name and Number:                                       Envirolab Services
Project Mgr:                                                                                                                                            12 Ashley St, Chatswood, NSW, 2067
Sampler:                                                                          PO No.:
Address:                                                                          Envirolab Services Quote No. :                                        Phone: 02 9958 5801
                                                                                  Date results required:                                                Fax:    02 9958 5803
Email:                                                                            Or choose: standard / 1 day / 2 day / 3 day                           E-mail:
                                                                                  Note: Inform lab in advance if urgent turnaround is required -
Phone:                                        Fax:                                surcharge applies                                                     Contact: Tania Notaras
                              Sample information                                                                                       Tests Required                                          Comments

                                                                                                                                                                                            Provide as much
Envirolab                                         Date
                     Client Sample ID                         Type of sample                                                                                                             information about the
Sample ID                                       sampled
                                                                                                                                                                                           sample as you can

Relinquished by (company):                                                        Received by (company):                                                Samples Received: Cool or Ambient (circle one)
Print Name:                                                                       Print Name:                                                           Temperature Recieved at:          (if applicable)
Date & Time:                                                                      Date & Time:                                                          Transported by: Hand delivered / courier
Signature:                                                                        Signature:                                                                                           Page No:
          Form: 302 - Chain of Custody-Client, Issued 14/02/08, Version 3, Page 1 of 1.

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