| Sample ID | Date Collected | ||
|---|---|---|---|
| Site/Location | Time Collected | ||
| Collected By | Sample Type (e.g., surface, equipment) | ||
| Swab Area Description | |||
| Swab Method | Swab Lot # | ||
|---|---|---|---|
| Area Swabbed (cm²) | Purpose of Sampling | ||
| Notes | |||
| Date/Time | Released By (Name/Signature) | Received By (Name/Signature) | Purpose/Comments |
|---|---|---|---|
| Received By | Date/Time | ||
|---|---|---|---|
| Condition of Sample Upon Receipt | |||