(203)-980-6594 - 176 Amity Rd., #300 - Woodbridge, CT 06525 – Job I.D.:
Microbiology Chain of Custody Client Name
Project Street Address
Client Address
Project City/State
City/State
Project I.D. #
Collection Date
Project Name
Sample No.
Sample Location
Sample Turn Around Time Standard ☐ Next Day ☐ Same Day
☐
Sample Type
Total Volume
Sample Type AC – Air Cassette TL – Tape Lift
Inspector/Relinquished by:
Date & Time:
Received/Analyzed by:
Date & Time: