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Appendix E: Chain of Custody

Chain of custody form Sheet of
This column for lab use only From: Date: To: Container size, type, preservative and analysis
Container identification

Job code:

Insert your office address here



















Preservative code








Due date: Project no: Sampler(s): Analytes              
Project manager: Signature(s):
Agreement no: Checked:
Custody seal intact? Released by: Received for laboratory by:
Yes No
Sample cold? Date: Time: Date: Time:
Yes No
Lab identification Date Time Matrix Sample number Comments Total no Tick required analytes
Remarks: Total                
Courier job no: * Container type and preservative codes: P = neutral plastic; N = nitric acid preserved; C = sodium hydroxide preserved; J = solvent washed acid rinsed jar; S = solvent washed acid rinsed glass bottle; VC = hydrochloric acid preserved vial; VS = sulphuric acid preserved vial; BS = sulphuric acid preserved glass bottle; Z = zinc acetate preserved bottle; E = EDTA preserved bottles; ST = sterile bottle
Specify turnaround time: Note: Samples may contain dangerous and hazardous substances