1. Chain of Custody Form
Date Sample Collected
Site ID and Description
Time Sample Collected
Number of Samples
Sample Source:
Sampler Name (printed):
Sampler Signature:
Recreational Waters
Other Waters (please specify)
Place sample on ice immediately. Deliver to the Lab within 6 hours of sampling.
Field Data
Dissolved Oxygen (mg/L)
pH
Salinity (ppt)
Air Temperature (0C)
Tide Stage
Secchi Disk Transparency
(meters)
Weather Conditions
Algae Cover
Total Depth
(meters)
Water Temperature (0C)
Water Color
Sample Depth
(meters)
Water Conditions
Water Odor
Last Significant Precipitation
(runoff)
Water Surface
Water Clarity
Rainfall Accumulation
(last 3 days)
Laboratory Use Only
Analytical Method:
Sample Condition:
Volume Analyzed:
Comments:
Relinquished By: __________________________________
Date / Time: ______________________________
Received By Lab: __________________________________
Date / Time: ______________________________