Chain of custody form

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Chain of custody form

  1. 1. Chain of Custody Form Date Sample Collected Site ID and Description Time Sample Collected Number of Samples Sample Source: Sampler Name (printed): Sampler Signature: Recreational Waters Other Waters (please specify) Place sample on ice immediately. Deliver to the Lab within 6 hours of sampling. Field Data Dissolved Oxygen (mg/L) pH Salinity (ppt) Air Temperature (0C) Tide Stage Secchi Disk Transparency (meters) Weather Conditions Algae Cover Total Depth (meters) Water Temperature (0C) Water Color Sample Depth (meters) Water Conditions Water Odor Last Significant Precipitation (runoff) Water Surface Water Clarity Rainfall Accumulation (last 3 days) Laboratory Use Only Analytical Method: Sample Condition: Volume Analyzed: Comments: Relinquished By: __________________________________ Date / Time: ______________________________ Received By Lab: __________________________________ Date / Time: ______________________________

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