Fillable CHAIN OF CUSTODY Environmental Testing Inc. 4619 N.

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CHAIN OF CUSTODY Environmental Testing Inc. 4619 N.

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Page of
Environmental Testing Inc.
4619 N. Santa Fe
Oklahoma City, OK 73118
COC Number
Lab Work Order Number
Phone
Sample Name or Field ID Sampled Date
Sampled
Time
Sample Type
Code
Matrix
Code
Container
Count
Date/Time
Date/Time
Date/Time
Matrix Codes:
CHAIN OF CUSTODY
Phone: (405) 488-2400
Fax: (405) 488-2404
PO Number
Sampler Signature
Due Date
Rush requests subject
to lab approval.
Relinquished By
Received By
Received By
Received By
Client Name Project Name
Client Contact
City
Project Number
Project Description
Shipped By
Tracking Number
Relinquished By
State/Zip
Sampler
Address
Fax
Requested Analyses
Standard (days)
Preservation Code
Expedited (days)
Requested Turn Around
Rush requests subject
to additional charge.
Preserv. Codes:
Cooler Numbers and Temperatures
Comments
Sample
Comments
Relinquished By
ETI_COC_template_rev2.2
ITDEPT-COC-16
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Completed 5 February 2021

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