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~. <br />~~ <br />INSTRUCTIONS FOR COMPLETING CHAIN-OF-CUSTODY RECORD ,~; <br />f <br />~: <br />efo <br />Record the client name, address, contact, and a phone and fax number where the <br />client contact can be reached in case of questions. <br />Project ID/Description: Record the name of the project or client/site location, and thE~ <br />project number as assigned by the field team. (example-613215; x,y,z Chemical Co., <br />WA). <br />P. O.: Record a purchase order number for billing and reference purposes. <br />Sample Matrix: Use one (1)chain-of-custody record per sample matrix. Circle the <br />matrix which most accurately represents the samples included on the C-O-C, (ie. <br />water, soil, oil, sludge). For murtiphasic samples (eg. oil and water), or anon-listed <br />matrix, circle "other" and describe the matrix in the space provided. <br />Date and Time Collected: Record the date and exact time each sample was collectE~d. <br />Use 24 hr. clock. <br />Client ID: List the complete identifying name/number of each of the samples you send. <br />These ID's must correspond with the identifying labels on the sample containers. <br />Number of Containers: Indicate the number of containers being shipped forthe re- <br />spective samples. <br />Test Requested: In the vertical spaces denoted "Tests Requested", indicate all para- <br />meters for which the samples will be analyzed. <br />Comments: The comment section can be used to record the waybill or air bill numb~~i <br />ii the samples are being sent by a shipping company, any special instructions to the <br />laboratory regarding the processing of the samples or an indication if the samples are <br />suspected to contain high concentrations of any hazardous materials. <br />Signatures: When releasing custody of these samples, use the "Relinquished By" <br />spans to sign your full name, date and time of release. After verifying that all samplE~s <br />indicated are present, the person receiving the samples will sign in the "Received By" <br />spans to take custody of the samples. <br />All oYh.er sections of the C-O-C record are for Analytica use, and should be left blank. <br />• <br />