Environmental Testing Laboratory | Environmental Analysis ...



|[pic] |Date Rec’d in Lab:       |

|CHAIN OF CUSTODY PAGE    OF    |ALPHA Job #:       |

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| |Report Information Data Deliverables |

| |Billing Information |

|Project Information | |

| |FAX |

|Westborough, MA Mansfield, MA |EMAIL |

|TEL: 508-898-9220 TEL: 508-822-9300 |Same as Client info |

|FAX: 508-898-9193 FAX: 508-822-3288 |PO #:       |

|Project Name:       | |

| |ADEx |

|Client Information |Add’l Deliverables |

|Project Location:       | |

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|Client:       |Regulatory Requirements/Report Limits |

|Project #:       | |

| |State/Fed Program |

|Address:       |Criteria |

|Project Manager:       | |

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|ALPHA Quote #:       | |

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|Phone:       | |

|Turn-Around Time | |

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|Fax:       | |

|Standard Rush (ONLY IF PRE-APPROVED) | |

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|Due Date:       Time:       | |

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|Email:       | |

| |ANALYSIS |

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|These samples have been Previously analyzed by Alpha |SAMPLE HANDLING |

| |Filtration |

| |Done |

|Other Project Specific Requirements/Comments/Detection Limits: |Not Needed |

|      |Lab to do |

|      |Preservation |

|      |Lab to do |

|      |(Please specify below) |

| |T |

|ALPHA Lab ID |O |

|(Lab Use Only) |T |

|Sample ID |A |

|Collection |L |

|Sample | |

|Matrix |# |

|Sampler’s | |

|Initials |B |

| |O |

| |T |

| |T |

|Date |L |

|Time |E |

| |S |

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| |Sample Specific Comments |

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FORM NO: 01-01(I-NJ)

(rev. 5-JAN-12)

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