Forensic Analytical Laboratories, Inc. Water Microbiology Analysis Request Form (COC) Company: Client No.: Date: Street: City: State: Zip: Contact: Phone: Fax: Email: Site: / Job#: Comments: Turnaround Time: DUE DATE: DUE TIME: Report Via: Fax Email Verbal For Lab Use Only Type Hold Time Met? Sample (Drinking, Waste, Volume Y/N Sample Location & Water System Analysis Requested Water Temp. Sample ID Date / Time Recreational, Surface, Collected DW=30hr Upon Receipt Process, etc) (mL) S/RW=8hr WW=6hr Sampled By: Date: Time: Shipped Via: Fed Ex DHL Airborne UPS US Mail Courier Drop Off Other: Relinquished By: Relinquished By: Relinquished By: Date / Time: Date / Time: Date / Time: Condition Acceptable? Yes No Condition Acceptable? Yes No Condition Acceptable? Yes No Received By: Received By: Received By: Date / Time: Date / Time: Date / Time: Condition Acceptable? Yes No Condition Acceptable? Yes No Condition Acceptable? Yes No
Forensic Analytical Laboratories, Inc. Water Microbiology Analysis Request Form (COC) Company: Client No.: Date: Street: City: State: Zip: Contact: Phone: Fax: Email: Site: / Job#: Comments: Turnaround Time: DUE DATE: DUE TIME: Report Via: Fax Email Verbal Sample ID Sample Date / Time Sample Location & Water System Volume Collected (mL) Type (Drinking, Waste, Recreational, Surface, Process, etc) Analysis Requested For Lab Use Only Hold Time Met? Y/N DW=30hr S/RW=8hr WW=6hr Water Temp. Upon Receipt Sampled By: Date: Time: Shipped Via: Fed Ex DHL Airborne UPS US Mail Courier Drop Off Other: Relinquished By: Date / Time: Condition Acceptable? Yes No Relinquished By: Date / Time: Condition Acceptable? Yes No Relinquished By: Date / Time: Condition Acceptable? Yes No Received By: Date / Time: Condition Acceptable? Yes No Received By: Date / Time: Condition Acceptable? Yes No Received By: Date / Time: Condition Acceptable? Yes No
mic_water_coc.docx