"Chain of Custody Form - Rmb Environmental Laboratories, Inc"

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CHAIN OF CUSTODY RECORD
RMB
Environmental Laboratories, Inc.
Page
of
22796 County Highway 6, Detroit Lakes, MN 56501
Electronic version available at http://www.rmbel.info/lab/chains-of-custody/
phone & fax: 218-846-1465 ∙ rmbel@rmbel.info ∙ www.rmbel.info
Client:
Phone #:
Fax #:
Analysis Requested
Project Name:
Project Task Code:
PO/WO #:
Samplers: (print first & last name)
Samplers: (signature)
Sample Comments:
Start
End
(Equipment Type,
# of
Depth
Depth
Sample
Filtration, AIS,
Lab Code
Station ID/Sample Description
Date
Time
Bottles Sample Method
(m)
(m)
Type
Matrix
Preservation)
________ (Initials) In the event that samples are received by the lab at a temperature greater than 6 ° C, I hereby authorize RMB Environmental Laboratories to process the samples as received.
________ (Initials) In the event that samples are received by the lab at a temperature greater than 6 ° C, please contact client at phone # ______________________before processing samples.
Relinquished by: (signature)
Date
Time
Received by Lab: (signature)
Date
Time
BILLING
Shipping:________________
Shipping Method
Electronic Data Deliverable (EDD): Lab_MN format
DOES meet proper sample storage and transportation guidelines
Speedee
Mileage:________________
Report to:
Does NOT meet proper sample storage and transportation guidelines
UPS
Explain:__________________________________________________
Field Staff:______________
USPS
Rcvd on ice
Rcvd at room temp
Rcvd Temp:____________° C
FedEx
Equipment:_____________
Samples received same day as collection
Bill to:
Hand Delivery
Comments:_______________________________________________
Other:_________________
Other:_______
PJS 4/17/2015
Use Adobe Acrobat Reader to open and fill out this form. A free download is available at https://get.adobe.com/reader/
CHAIN OF CUSTODY RECORD
RMB
Environmental Laboratories, Inc.
Page
of
22796 County Highway 6, Detroit Lakes, MN 56501
Electronic version available at http://www.rmbel.info/lab/chains-of-custody/
phone & fax: 218-846-1465 ∙ rmbel@rmbel.info ∙ www.rmbel.info
Client:
Phone #:
Fax #:
Analysis Requested
Project Name:
Project Task Code:
PO/WO #:
Samplers: (print first & last name)
Samplers: (signature)
Sample Comments:
Start
End
(Equipment Type,
# of
Depth
Depth
Sample
Filtration, AIS,
Lab Code
Station ID/Sample Description
Date
Time
Bottles Sample Method
(m)
(m)
Type
Matrix
Preservation)
________ (Initials) In the event that samples are received by the lab at a temperature greater than 6 ° C, I hereby authorize RMB Environmental Laboratories to process the samples as received.
________ (Initials) In the event that samples are received by the lab at a temperature greater than 6 ° C, please contact client at phone # ______________________before processing samples.
Relinquished by: (signature)
Date
Time
Received by Lab: (signature)
Date
Time
BILLING
Shipping:________________
Shipping Method
Electronic Data Deliverable (EDD): Lab_MN format
DOES meet proper sample storage and transportation guidelines
Speedee
Mileage:________________
Report to:
Does NOT meet proper sample storage and transportation guidelines
UPS
Explain:__________________________________________________
Field Staff:______________
USPS
Rcvd on ice
Rcvd at room temp
Rcvd Temp:____________° C
FedEx
Equipment:_____________
Samples received same day as collection
Bill to:
Hand Delivery
Comments:_______________________________________________
Other:_________________
Other:_______
PJS 4/17/2015
Use Adobe Acrobat Reader to open and fill out this form. A free download is available at https://get.adobe.com/reader/
SAMPLE METHOD:
CF
= Composite sample with auto-sampler
G-EVT
= Grab sample collected in response to an event
CF-F
= Composite sample, flow-weighted/flow-paced with auto-sampler
LAKE SED
= Lake sediment sample grab
CF-T
= Composite sample, flow-weighted/time-paced with auto-sampler
LKDEPTH
= Lake depth point sampling. Lake water is sampled at a discrete depth
CG-T
= Composite of grab samples, time-paced. Individual grab samples
in the water column using a vertical Kemmerer or Van Dorn-type sampler.
taken over time are composited for a single result.
LKDEP_INTEGR
= Lake depth integrated sampling
CO
= Composite sample (other)
LKSURF1M
= Lake surface 1m depth-integrated sampling
CT
= Composite sample, time-paced auto-sampler. Automatic
LKSURF2M
= Lake surface 2m depth-integrated sampling
composite sampling at regular time intervals.
LKSURFOTH
= Lake surface depth-integrated sampling other than 0-2m
CT-T
= Composite sample, flow-triggered, time-paced, auto-sampler.
Other
= Other sampling method
Automatic sampling at regular time intervals triggered by a pre-set
QC-BLANK
= Quality control blank. No sample collected.
increase in stream water level.
SW-BASIC
= Generic groundwater sampling
CT-U
= Composite sample, time-paced, trigger unknown, auto-sampler.
SW-SOIL
= Soil sampling
Automatic composite sampling at regular time intervals.
Unknown
= Unknown sampling method
D-T
= Discrete sample, time-paced with auto-sampler
WELL-BAIL
= Bail. For wells that cannot be pumped.
G
= Grab sample. Submerge and fill a water sampling vessel, or sample
WELL-NONSUBMERS
= Non-submersible. For shallow monitoring wells without pump.
directly into the sample bottle provided by the analytical
WELL-SUBMERS
= Submersible. For domestic/deep monitoring wells with pump.
laboratory, at a single point in a water body.
SAMPLE TYPE:
MATRIX:
EQUIPMENT TYPE:
QC-EB
= Quality Control Sample-Equipment Blank
Eff-Ind
= Industrial Effluent
NVPL
= Net/Vertical Tow: Plankton Net
QC-FB
= Quality Control Sample-Field Blank
Eff-Septic
= Septic Effluent
WSBK
= Water Sampler: Bucket
QC-FR
= Quality Control Sample-Field Replicate
Eff-WWTP
= Wastewater Treatment Plant Effluent
WSKM
= Water Sampler: Kemmerer Bottle
QC-FSub = Quality Control Sample-Field Subsample
Inf-WWTP
= Wastewater Treatment Plant Influent
WSNA
= Water Sampler: Nansen Bottle
QC-IP
= Quality Control Sample-Inter-lab Split
QC-BLANK
= Quality Control Blank
WSNI
= Water Sampler: Niskin Bottle
QC-TB
= Quality Control Sample-Trip Blank
Sludge
= Sludge
WSOTH = Water Sampler: Water Sampler (Other)
Sample = Sample-Routine
Soil-Sub
= Subsurface Soil/Sediment
WSSY
= Water Sampler: Syringe
S-CWOP = Sample-Composite Without Parents
Soil-Surf
= Surface Soil/Sediment
WSVC
= Water Sampler: Vinyl Tube
S-CWP
= Sample-Composite With Parents
Waste-Ind
= Industrial Waste
WSVD
= Water Sampler: Van Dorn Bottle
S-FP
= Sample-Field Split
Waste-Mun = Municipal Waste
WSWB
= Water Sampler: Water Bottle
S-ICSP
= Sample-Integrated Cross-Sectional Profile
Wtr-Drink
= Drinking Water
WSWP
= Water Sampler: Whirl-pak bag
S-IFP
= Sample-Integrated Flow Proportioned
Wtr-Finish
= Finished Water
S-IHP
= Sample-Integrated Horizontal Profile
Wtr-Ground = Ground Water
S-ITS
= Sample-Integrated Time Series
Wtr-Pore
= Interstitial Water
S-IVP
= Sample-Integrated Vertical Profile
Wtr-Rain
= Rain Water
S-O
= Sample-Other
Wtr-Snow
= Snowmelt
Wtr-Storm
= Stormwater
Wtr-Surf
= Surface Water
DESCRIPTIONS:
QC-EB: Sample of analyte free water poured over or through decontaminated field sampling equipment prior to the collection of environmental samples.
QC-FB: Sample of analyte free water poured into a sample container in the field, preserved and shipped to the laboratory with field samples.
QC-FR: Multiple samples taken within each combination of time, location, and any other controlled variables.
QC-IP: One sample divided into two or more identical sub-samples, and analyzed at different laboratories.
QC-TB: Test samples of analyte-free media taken from the laboratory to the sampling site and returned to the laboratory unopened.
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