Environmental Testing Laboratory | Environmental Analysis ...
|[pic] |Date Rec’d in Lab: |
|CHAIN OF CUSTODY PAGE OF |ALPHA Job #: |
| | |
| |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: | |
| | |
|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 |
| | |
|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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