FOR LABORATORY USE ONLY Laboratory Project ID:___________________ Temp ___________ C Storage Secured: Storage ID: ___________________________ Yes No ( Name) See "Sample Log-in Checklist" for additional sample information Tracking No.: ATTN: Matrix Types: DW = Drinking Water, EF = Effluent, PP = Pulp/Paper, SD = Sediment, SL = Sludge, SO = Soil, WW = Wastewater, B=Blood/Serum O = Other Container Types: A = 1 Liter Amber, G = Glass Jar P = PUF, T = MM5 Train, O = Other *Bottle Preservative Type: T = Thiosulfate, O = Other SHIP TO: Vista Analytical Laboratory 1104 Windfield Way El Dorado Hills, CA 95762 (916) 673-1520 • Fax (916) 673-0106 SEND DOCUMENTATION AND RESULTS TO: Name: ___________________________________________ Company: ________________________________________ Address: _________________________________________ City: ________________ State: _____ Zip: _________ Phone: ___________________ Fax: __________________ Email: ___________________________________________ Special Instructions/Comments: Method of Shipment: Add Analysis(es) Requested Sample ID Date Time Location/Sample Description CHAIN OF CUSTODY RECORD Project I.D.: P.O. #: Sampler: Invoice to: Name Company Address City State Zip Ph# Fax # Relinquished by: (Printed Name and Signature) Date: Time: Received by: (Signature and Printed Name) Date: Time: Relinquished by: (Printed Name and Signature) Date: Time: Received by: (Signature and Printed Name) Date: Time: TAT: (Check One) Standard Rush (surcharge may apply) Container(s) 7 days 14 days 21 days Specify: *A printed COC must accompany all samples.
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FOR LABORATORY USE ONLY
Laboratory Project ID:___________________ Temp ___________ C
Storage Secured:Storage ID: ___________________________ Yes No
(Name)
See "Sample Log-in Checklist" for additional sample information
Tracking No.:ATTN:
Matrix Types: DW = Drinking Water, EF = Effluent, PP = Pulp/Paper,SD = Sediment, SL = Sludge, SO = Soil, WW = Wastewater, B=Blood/Serum
O = Other
Container Types: A = 1 Liter Amber, G = Glass JarP = PUF, T = MM5 Train, O = Other
*Bottle Preservative Type: T = Thiosulfate,O = Other
SHIP TO: Vista Analytical Laboratory1104 Windfield WayEl Dorado Hills, CA 95762(916) 673-1520 • Fax (916) 673-0106
SENDDOCUMENTATIONAND RESULTS TO:
Name: ___________________________________________Company: ________________________________________Address: _________________________________________City: ________________ State: _____ Zip: _________Phone: ___________________ Fax: __________________Email: ___________________________________________
Special Instructions/Comments:
Method of Shipment: Add Analysis(es) Requested
Sample ID Date Time Location/Sample Description
CHAIN OF CUSTODY RECORDProject I.D.: P.O. #: Sampler:
Invoice to: Name Company Address City State Zip Ph# Fax #
Relinquished by: (Printed Name and Signature) Date: Time: Received by: (Signature and Printed Name) Date: Time:
Relinquished by: (Printed Name and Signature) Date: Time: Received by: (Signature and Printed Name) Date: Time:
TAT: (Check One)StandardRush (surcharge may apply)
Container(s)
7 days14 days
21 days
Specify:
*A printed COC must accompany all samples.
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