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: firstname.lastname@example.org 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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