Petroleum Product Testing Sample Chain of Custody Form
Company/Client Name
Contact Person
Phone Number
Sample Location
Date/Time Collected
Collected By
Sample Description
Sample ID
Product Name / Type
Container Type
Volume
Testing Requested
Special Instructions / Comments
Laboratory Use Only
Date/Time Received
Received By
Condition
Remarks
Chain of Custody Record
Date/Time
Released By (Name/Signature)
Received By (Name/Signature)
Purpose/Remarks