Chemical Chain of Custody Instructions:

Step #1: Fill out company information

• Company:
  • Your company name, or if you are not a company put your name
• Address/City/State/Zip:
  • Your (company) address
• Phone:
  • Phone number we can contact you at
• Fax:
  • Fax number (optional)
• Contact:
  • The person we should ask for if we need to contact you
• Project ID:
  • Project ID can be left blank

Step #2: Fill out billing information 

• *If billing information is the same as company information, please write same**
• The address you would like us to mail your bill to

Step #3: Sample Location 

• For each sample fill out a line describing where the sample was located

Step #4: Sample Date 

• The date that the sample was taken

Step #5: Sample Time 

• The time, in military time, that the sample was collected from the source

Step #6: Number of containers 

• The number of containers brought in per sample location

Step #7: Matrix

• Mark the type of water (Ex. drinking, ground, etc.)

Step #8: Analysis Requested 

• * Mark the test(s) you would like performed on your sample
• If you would like a test run on your sample that isn't already in one of the columns under analysis requested, then in a blank column write in the desired test (Ex. chloride)

Step #9: Sampled by

• The samplers name

Step #10: Special Instruction

• Any further comments about the sample.

Step #11: Relinquish sample 

• Sampler signs to relinquish sample to the water lab.
• If another person besides the sampler brings in the water sample, the sampler must sign the first signature line to relinquish custody of the sample to the person bringing it to the water lab. When that person brings the sample to the lab, they will need to sign the next signature line to relinquish the sample from them into our custody.