Environmental Chemistry
Chain of Custody
PHONE:
FAX:
EMSL Order Number (Lab Use Only):
Report To Contact Name:
Bill To Company:
Company Name:
Attention To:
Street:
Street:
Fax :
No
Samples Collected by: EMSL
Standard Turnaround Time:
If yes, NPDES?
Client
2 Weeks
Grab
Comp
Collect
Date/Time
Released By (Signature)
Please indicate reporting requirements:
Fax:
Email Results To:
Purchase Order:
Number of Samples in Shipment:
Date of Shipment:
Other (Specify):
check one
Sampled By (Signature):
The following TATs are subject to lab approval:
Failure to complete will hinder processing of samples
Matrix
Preservative
W=Water
S=Soil
A=Air
SL=Sludge
O= Other
1=HCL
2=HNO3
3=H2SO4
4=ICE
5=Other
Date & Time
Results Only
Instructions or Comments:
Zip/Postal Code:
1 Week
4 Days
List Test(s) Needed
Received By
Results and QC
Samples Received Chilled (Y/N)
3 Days
2 Days
1 Day
Reduced Deliverables
Field Temp.
Test Time
Sample for Compliance? Yes
State/Province:
Phone:
Project Name:
U.S. State where Samples Collected:
Client Sample ID
City:
Field Temp.
Deg C
Phone :
Zip/Postal Code:
Field pH
Test Time
State/Province:
Field pH
City:
Comments
Date & Time
Disk Deliverable
Other _______
Note:Field pH and Field Temperature are tested on the same day as the date of sample collection.
(Lab) Received Temperature: _______°C
Page 1 of _____ pages
Controlled Document – COC-07 Environmental Chemistry – R7.1 – 2/14/2017
Environmental Chemistry
Chain of Custody
PHONE:
FAX:
EMSL Order Number (Lab Use Only):
Additional Pages of the Chain of Custody are only necessary if needed for additional sample information
List Test(s) Needed
Field Temp
Test Time
1=HCL
2=HNO3
3=H2SO4
4=ICE
5=Other
Field Temp
Deg C
Preservative
Field pH
Test Time
Collect
Date/Time
Matrix
W=Water
S=Soil
A=Air
SL=Sludge
O= Other
Field pH
Grab
Client Sample ID
Comp
Failure to complete will hinder processing of samples
Comments
(Lab) Received Temperature: _______°C
Controlled Document – COC-07 Environmental Chemistry – R7.1 – 2/14/2017
Page ______ of ______ pages