Chain of Custody Record for Asbestos Bulk Samples Batch #: 1. CDB Bldg. No.: 2. CDB Project #: 3. Facility Name: 4. Building Name: Date Samples Collected: 5. 6. Name of Inspector: Project Name: 7. 8. License #: Sample Numbers: 9. 10. Total # Samples: 11. Total # Samples: 12. Sample numbers relinquished: Representing: Relinquished by: Signature: Method of Transmission: Date and Time: Total # Samples: Sample numbers received: Representing: Received by: Signature: Condition of Sample Upon Receipt: Date and Time: Reason for Obtaining Sample: Total # Samples: 13. Sample numbers relinquished: Representing: Relinquished by: Signature: Method of Transmission: Date and Time: Total # Samples: Sample numbers received: Representing: Received by: Signature: Condition of Sample Upon Receipt: Date and Time: Reason for Obtaining Sample: Total # Samples: 14. Sample numbers relinquished: Representing: Relinquished by: Signature: Method of Transmission:
Chain of Custody Record for Asbestos Bulk Samples 1. CDB Bldg. No.: 2. Batch #: 3. Facility Name: 4. CDB Project #: 5. Building Name: 6. Date Samples Collected: 7. Name of Inspector: 8. Project Name: 9. License #: 10. Sample Numbers: 11. Total # Samples: 12. Sample numbers relinquished: Total # Samples: Relinquished by: Representing: Signature: Method of Transmission: Date and Time: Sample numbers received: Total # Samples: Received by: Representing: Signature: Condition of Sample Upon Receipt: Date and Time: Reason for Obtaining Sample: 13. Sample numbers relinquished: Total # Samples: Relinquished by: Representing: Signature: Method of Transmission: Date and Time: Sample numbers received: Total # Samples: Received by: Representing: Signature: Condition of Sample Upon Receipt: Date and Time: Reason for Obtaining Sample: 14. Sample numbers relinquished: Total # Samples: Relinquished by: Representing: Signature: Method of Transmission:
FORM%2015%20-%20Chain%20of%20Custody.docx