Laserfiche WebLink
Testrica Sacraenta Chain of Custody Record �"?' �"'�� ' <br /> tl$�� ay X11 L� TestAmedca <br /> Us+ sbcra featfl? CR 95"S THE LEADER IN ENVIRONMENTAL TESTING <br /> Pte' n6.373.5546 Fax: TestAmerica Laboratories,Inc. <br /> Regulatory Program: ❑DW ❑NPDES ElRCRA E]Other: TAL-8210(0rt31. <br /> Client Contact Project Manager:( Site Contact: Date: COC No: <br /> Company Name: Tel/Fax: Lab Contact: Carrier: of COCs <br /> Address: [ . - Analysis Turnaround Time Sampler: <br /> City/State/Zip: ,_ ,;' ❑ CALENDAR DAYS F WORKING DAYS For Lab Use Only: <br /> Phone: f - TAT if different from Below . Z Walk-in Client: <br /> Fax: <br /> ❑ 2 weeks Z } Lab Sampling: <br /> Project Name: - <br /> t ❑ 1 week <br /> •Site: } � <br /> El days a Job/SDG No.: <br /> Pte# <br /> ❑ 1 day E <br /> rn <br /> Sample in <br /> Te <br /> a E <br /> Sample Sample (c co <br /> mp, #of d <br /> Sample Identification Date Time G=Grab) Matrix Cont. LL a I I I Sample Specific Notes <br /> f. f <br /> j. <br /> Preservation Used: 1=Ice, 2=HCl: 3=H2SO4. 4=HN0 <br /> 3, S=NaOH;6---Other <br /> Possible Hazard Identification: Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> Are any samples from a fisted EPA Hazardous Waste? Please List any EPA Waste Codes for the sample in the <br /> Comments Section if the lab is to dispose of the sample. <br /> ❑Non-Hazard ❑Flammable _Skin Irritant ❑Poison B f ❑Unknown <br /> ❑Return to Client Q Disposal by Lab E]Archive for Months <br /> Special Instructions/QC Requirements 3 Comments: <br />'- Custody Seals Intact: ❑ Yes ❑ No Custody Seal No.: ' :{ I Cooler Temp. }: : bs'd: Cared: harm ID No.: <br /> Relinquished by' Company: b e7Tfine: Received by: ; \ Company: Date/Time: <br /> 1 Relinquished by Company: Date/Time: Receivea-by:,.I Company: Date/Time: <br /> Relinquished by: Company: Date/Time: Received in Laboratory by Company: Date/Time: <br />